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Working under the general direction of the Director, Senior Manager, and Manager of the Group Practice Management department (GPM) in the Professional Billing Office (PBO), the Professional Revenue Cycle Account Manager serves as the primary contactbetween designated practices and the PBO for all aspects relating to the professional services Revenue Cycle. Working closely with Practice and physician leadership, the PRCAM is responsible for the proactive management of the billing process for the client relationship and a full assessment and understanding of the practice’s revenue cycle. This includes a thorough understanding of systems, process and service specific coding and billing requirements and proactively identifying opportunities for revenue cycle improvement initiatives. Develops and executes these initiatives and also provides the practices and PBO Management with the status and analysis of standard operational, financial, billing and budget statistics on a monthly basis. The MGPO Professional Billing Office is the central billing office for physician practices affiliated with Partners Healthcare members including the Massachusetts General Hospital in Boston, Massachusetts, Newton Wellesley Hospital and North Shore Medical Center. Several Partners affiliated Private practices also utilize MGPO PBO services.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Establishes and manages effective ongoing communication with assigned physician practice(s) to identify and address business needs; provides guidance and timely responses to customer service questions and requests; conducts regular meetings with practice staff. Communicates with practice(s) within the framework of the Revenue Cycle. Provides analysis and context for monthly performance data. This includes projections and comparison to budget figures.
Effectively manages group or practice’s expectations regarding financial performance. Maintains ongoing issues and priority list for practice/PBO. Completes analysis of issues for action, presents this information and implements or supervises action plans. Prioritizes initiatives with practice MDs or Directors on key performance issues. Proactively identifies sources of issues and communicates these to the appropriate parties. Provides practice(s) with updates on new initiatives within the PBO designed to improve billing performance
Provides practice(s)/PBO Management Team with statistical reports including but not limited to:
• total co-payment collections
• total encounters and charge reconciliations
• professional billing related edits
• charges held due to provider credentialing
• resolution of account credits and prepayments
• number of outstanding provider applications
• monthly write-offs
• payer rejections and claim denials
Understands the implication of each element in the revenue cycle, communicates this to group/practice to engender an appropriate response. Provides interpretation to clients/PBO Management. Develops interventions and initiates actions
Focuses practice(s) on issues that will positively impact financial performance. Provides updates on global issues regarding coding and reimbursement practice(s). Assesses impact of new regulations or codes from a coding, compliance and reimbursement perspective. Develops expertise for assigned practice(s). Works with practice leadership on annual budgeting, forecasting and analysis for potential new business opportunities
Supports the integration of new physicians/practice(s) into the PBO by providing professional charges by CPT code to PeC for dictionary modifications; assisting in the orientation/training of practice staff (coordinating with credentialing staff, Cadence, Ambulatory, Patient Service Center, Partners PeCare team. Monitors time of service payments, referral management, co-pay collection, discrepancy management and overall PBO structure/operations). Demonstrates understanding of group, division and billing area structure within EPIC. Points out particular issues that could arise in implementation of billing services for the MD or practice. Ensures that all implementation tasks are completed accurately and in a timely fashion. Does periodic quality assurance checks to ensure that process is running as expected
Establishes and develops collaborative relationships with internal staff. Works with PBO departments to modify procedures and update information (i.e. update practice level pick lists, billing instructions). Shares information with PBO staff to enhance departmental efficiency/performance (i.e. notifies ADs of audit and compliance risks, identifies issues through rejection or receivable analysis.) Provides back-up assistance to departments in need
Represents functional areas within PBO as a collaborative area of practice’s billing team. When requesting specific assistance from a functional area, provides detailed summary of request, with supportive data. Upon identification of issues, researches issue to determine whether it is an isolated instance or a trend and follows up with the Group Practice Manager and AD to facilitate communication to all parties within Group Management, the practice and the PBO
Develops standardized approaches for operational issues, reporting, and analysis and quality management. Reviews key measures on a regular basis and develops new measures as needed. Develops expertise in querying system for data and reports. Works closely on interface and system issues as required to improve flow of data.
Monitors practice activity utilizing the EPIC Dashboard and workbench reports. Ensures that charge and account receivables processing meets established service standards and works with Partners Billing Solutions to efficiently resolve self- pay issues and patient concerns.
Attends all department and Practice meetings as required.
Works collaboratively with Patient Financial Services, PBO Registration, Patient Service Center, PBO Coding, Payer Relations and their counterparts on the Hospital Revenue Integrity Team to insure efficient processing and follow up on all professional revenue.
Participates in committees and task forces as assigned
Other responsibilities that may from time to time be assigned QUALIFICATIONS:
Bachelors Degree strongly preferred or equivalent experience required
3-5 years experience in a professional healthcare setting required
Proficiency in Microsoft Office suite (Excel, Word, Access, Outlook) required, EPIC, Cognos, preferred
Ability to learn and assimilate electronic systems
Experience at an academic medical facility preferred
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
Understanding of healthcare billing, finance and accounting principals
Motivated to achieve Service Excellence
Ability to successfully manage numerous tasks simultaneously
Requires excellent oral and written communications skills
Ability to present to multiple levels of staff from VPs, to Ads, to Managers, to providers, to Billing Managers to front desk staff
Define problems, collect data, establish facts and draw valid conclusions
Ability to conduct training sessions
Proficiency in Microsoft Office suite (Excel, Word, Access, and Outlook) required
WORKING CONDITIONS:
The MGPO Professional Billing Office is located in the Charlestown Navy Yard campus
The hours are usually Monday through Friday 8:00 AM to 4:30 PM but vary according to the demands on this exempt salaried position
The work environment is very busy and dynamic
Staff is very collaborative and work together to solve issues with particular practice issues
There are often multiple conversations occurring at the same time – the staff needs to be able to handle an environment that is not quiet
SUPERVISORY RESPONSIBILITY:
The Revenue Cycle Account Manager has no direct reports however he/she is responsible for mentoring and providing some day-to-day supervision of Assistant Billing Manager who are assigned to work with him/her.
FISCAL RESPONSIBILITY:
The fiscal responsibility varies based on the practice (s) covered by the individual Revenue Cycle Account Manager but on average represents $20-50 million in Net Revenue.
