**Accounts Receivable Specialist, Business Office, Managed Care Unit Grade 5 Job Description: Under supervision and through the use of the Physician Organization (PO) practice management system, the Accounts Receivable Specialist performs billing and accounts activities that will maximize insurance reimbursement and promote faster payments. Performs extensive account follow up activities utilizing the Physician Organization Practice Management System (PMS). Investigates, analyzes and resolves problematic and delinquent accounts. Reviews insurance receivable for departments and notifies management of potential problems. Complies with PO departmental procedures and guidelines to appropriately resolve outstanding accounts. Utilizes ancillary applications and websites as a tool to retrieve medical documentation, claim status, eligibility, billing guidelines, or authorization/referrals to substantiate corrected claim submissions, written appeals, or coding reviews. Reads and interprets transactional data within patient accounts. Maintains detailed functioning knowledge of the PMS dictionaries. Comprehends Electronic Data Interchange (EDI) functionality and the general progression of data in the PMS and EDI systems. Understands and resolves payer edits and/or rejections. Reports deviations from departmental policies and procedures. Demonstrates knowledge of medical terminology, CPT, ICD-9, HCPCS, CCI edits, and HIPAA regulations. Remains acquainted with Managed Care carrier updates regarding claim submissions, claim appeals, grievance procedures, and policy changes by reviewing payer newsletters or alerts, or attending various workshops, seminars, or webinars. Maintains a working knowledge of all payer plans and specialties within the scope of the unit. Provides training assistance to new employees. Utilizes Microsoft Excel to sort, filter, summarize and identify various account receivable trends. Displays strong analytical skills by providing detailed and accurate follow-up on reports and projects. Interacts effectively with internal and external customers via telephone or email. Responds to inquiries from department liaisons and other interdepartmental staff regarding patient account status. Drafts professionally written appeal letters to overturn denied claims. Responds to carrier requests for medical documentation and other source documents. Establishes and maintains effective working relationships with carrier representatives. Must be able to prioritize and work on multiple tasks. Produces an acceptable volume of work while yielding quality results as measured against departmental and position standards. **Accounts Receivable Specialist – Business Office – Managed Care Contracting Grade 5 Job Description: Under the direction of the PO business Office Contracts Manager, the Accounts Receivable Specialist performs regular analysis of Managed Care contracted payment data to identify underpayment trends and payment errors in order to maintain adherence to policy terms for contracts. Performs regular Experian Healthcare Contract Management Module fee schedule analysis. Helps to compile data for reports for underpaid payments and recovered subsequent payments. Provides support to manager in administering global package program, case rate agreements and transplant evaluations grant services. Communicates with internal and external departments to administrator both the global package programs and internal grant accounts. Responsible for the analysis of underpaid data. Audits the Managed Care contracted payments for Weill Cornell Physician Organization Business Office (POBO) for payer non-compliance of contract negotiated terms. Maintains files that are audited for future review. Investigates and reports underpaid error trends in order to remedy problems. Ensures the accuracy of fee schedules loaded into the Experian Healthcare Contract Management application to assist in the analysis of payments from contracted Managed Care payers. Displays proficiency of Experian Healthcare Contract Management analysis module and how the module is structured for the analysis of contracted payments. Assists in preparing monthly ad hoc reports of underpaid and recovered managed care payments for regular Contract Compliance meeting with executive management members, as necessary. Provides assistance/recommendations in developing strategies for improving accuracy of compliance module, which will reduce false positive variances. Identifies managed care payer trends for payment errors and payment adherence in order to increase payment reimbursement. Aids in the administration the global package/case rate programs, which consists of compiling data through GE’s DBMS application for each case and develops reports to correctly administrator payments across all departments within the scope of the contract. Reconciles all payments. Demonstrates a solid understanding of payment/contract guidelines that apply to any of the package case arrangements, such as the NYP Global Package program, Cigna Life Source, GOL, OptumHealth-(URN) program, miscellaneous agreements and our internal Pre-TPX evaluations services for potential Kidney/Liver patients. Must have a solid foundation of GE’s practice management system, NYP Eagle system and Receivable Edge document retrieve system. Keeps current of any changes that occur in managed contracts and global package/case arrangements. Works with other internal departments, NYP Hospital and Rogosin Institute to ensure that global package program procedures are being followed in order to maximize reimbursement and compliance. Confers with Managed Care contracting staff in for contract term clarification when necessary. **Revenue Cycle Analyst - Business Office Grade 7 Job Description: The Account Manager serves as the primary contact between The Weill Cornell Physician Network group practice (s), and the Professional Billing Office on all aspects relating to the billing of professional services. Works closely with PO Business Office Senior Management and physician leadership of practice, the Account Manager is responsible for the following: (1) The pro-active management of the billing process and the client relationship; (2) Full assessment and understanding of the practices revenue cycle, which includes a thorough understanding of systems, process and service specific coding and billing requirements; (3) Pro-actively identifying opportunities for revenue cycle improvement initiatives and developing and executing these plans; (4) Providing practice and POBO management with interpretation of standard operational, financial, billing and budget statistics on a monthly basis. Effectively manages group or practices expectations regarding financial performance. Maintains ongoing issues and priority list for practice and PO. Researches issues 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 POBO. 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. 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 request; 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. Establishes and develops collaborative relationships with internal staff. Works with departments to modify procedures (i.e. Batch Control, charge entry procedures) and update information (i.e. update encounter forms, billing instructions.) Shares information with BO staff to enhance departmental efficiency/performance. Provides back-up assistance to departments in need. Represents functional areas within PO 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 issues 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 POBO. Develops standardized approaches for operational issues, reporting and analysis 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 improving flow of data. Assists practice with statistical analysis. Consults with Management Team to identify issues and trends that contribute to variances and below par performances. Makes recommendations to address issues. Ensures that PO Benchmarks are maintained at all times. If necessary, will substitute for the POs Account Receivables Managers or Senior Accounts Receivable Managers. Understands the implications of each element in the revenue cycle, communicates this to group/practice to engender an appropriate response. Provides interpretation to clients/PO Management. Develops interventions and initiates actions. In conjunction with the Assistant Director, reviews monthly accounts receivable and statistical reports with the clinical department chairmen, administrators and/ or Billing Managers. Performs other related duties as assigned. **Payment Posting Supervisor – Business Office – Payment Posting Unit Grade 6 Job Description: The Payment Posting Supervisor oversees the daily operations of the comprehensive cashiering services of the Physician Organization Business Office Payment Posting Unit. The Payment Posting Supervisor serves as the primary day to day contact for the payment posting unit staff for all aspects relating to posting policy and procedures of the professional billing services. Trains and orients new staff to the policies and procedures of the unit, practice specific billing processes and the policies of the Physician Organization Business Office. Collaborates with the manager to evaluate, analyze, and identify opportunities to improve payment posting processes. Responsible for daily assignment distribution to the payment posting staff, monitors daily staff performance for productivity and quality. Evaluates performance and provides feedback and instruction to staff members. Assists in the hiring process. Provides manager with recommendations of any required disciplinary actions relating to work performance. Under guidance from the Payment Posting Manager, develops strategies to improve overall transaction posting performance for the Business Office. Assists the manager in creating policy and procedure and operational benchmarks and develops reports that measure department performance. Analyzes transaction activity and compares time posting to administrative duties to determine true productivity. Supervises the daily activities of employees within the payment posting unit. Manages the daily processes in place, which ensures all Lockboxes, EDI and other posted receipts are reconciled against validated system output sources, such as batch proofs and other reports. Ensures cash and audit control procedures implemented by the payment unit are adhered to on a daily basis; reports any cash discrepancies to the manager and department administrator immediately. Monitors and evaluates staff performance and productivity utilizing available practice management tools and other related reports. Documents all findings and provides feedback to staff based on findings and disciplines staff as needed. Assists Manager in assessing personnel needs, evaluating performance and makes recommendations in preparation of performance appraisals as well as any disciplinary action related to work performance. Executes performance improvement plans created by manager to distribute to staff. Creates monitors and communicates team goals. Assists the manager with preparation of monthly staff meetings to provide feedback and communicate new initiatives and policy changes. Evaluates process flow and makes operational changes to improve efficiency. Designs and implements strategies to improve overall performance. Acts as a liaison between all departments and the PO Business Office for all payment posting policies and procedures. Acts as a liaison between Weill Cornell and JP Morgan Chase for all Lock Box and EFT deposit inquiries. Cross-trains staff members on the different practices serviced by the PO Business Office to ensure appropriate staff coverage and to enhance and encourage skill development. Consults with ITS Support Team on problems related to the Practice Management System and remit files. Alerts manager and Professional Billing Administrator on resolution of issues. Works closely with the Credit Resolution Account Supervisor to ensure all credits and suspense account entries are posted correctly and all back up documentation is forwarded in a timely manner. Manages and monitors the daily distribution of staff assignments and time management. Provides guidance and resolution to the staff members in the PO Posting Unit. Orient and train new and existing payment posting staff on all new procedures. Monitors, evaluates and maintains all employee time record keeping documents. Collects and reviews time sheets validating information against the daily sign in/out sheets. Maintains record of scheduled/unscheduled un-scheduled vacation, personal and sick time, or occurrences of lateness prior to submission for processing. Participates in the interview process to screen potential candidates and evaluate skill sets against position requirements. Trains and orients new staff to the policies and procedures of the payers, practices, and PO Business Office including the use of the PMS and web based applications utilized to process payments. Provides feedback and development goals to employee on a regular basis during the probationary period based on documented findings. Makes recommendations to manager regarding the performance levels for the probationary review. **Senior Accounts Receivable Manager - Business Office - Government Unit Grade 7 Job Description: Under guidance from the Professional Billing Administrator and the Assistant Director of the PO Business Office plans, directs, manages and evaluates the collection activities for the Government Payers unit of the POBO. Develop strategies to improve overall performance in cash collections, days-in-accounts receivable and net collection rates. Increases Medicare, Medicaid, Workers Compensation and No Fault and Commercial cash flow. Resolves aged receivables by directly managing approximately 40 accounts receivable specialists and three supervisors. Hires, fires, evaluate performance and conducts salary reviews. Develops productivity standards. Prioritizes work of A/R staff. Analyzes aged accounts receivables for clinical departments and develops strategies for enhancing cash collections and expeditious account resolution. Identifies trends in payments and denials. Presents action plans to PO Business Office senior management. Develops targets for revenue, write-offs, collection referrals and action plans to meet goals. Monitors to ensure targets are met. Revises action plans as needed. Utilizes practice management standard and customized reports to analyze accounts receivables and ensure financial and operational targets are met. Identifies problems and develops action plans for resolution. Presents findings to clinical practices and POBO senior management. Communicates regularly and develops relationships with payers to resolve unpaid receivables. Conducts meetings and negotiates settlements where appropriate. Keeps abreast of changes in industry and governmental regulations that impact physician billing and reimbursement. Researches, develops, implements and trains staff on the use of the practice management and non-practice management applications to maximize revenue and increase operational efficiencies. Understands the implications of each element in the revenue cycle. Consults with the management team to identify issues and trends that contribute to variances and below par performances. Makes recommendations to address issues. Creates productivity benchmarks, and develop strategies to enhance revenues as well as streamline billing processes. Must be able to create and enforce billing policies and analysis and coaching to improve receivable process. On a monthly basis, documents unit financial activity summarizing all monthly financial reports for trend analysis. On a quarterly basis, conduct PowerPoint presentations on the financial performance of the Government Payers unit. Presentation material should focus on cash collection verses cash projections, days in accounts receivables, and beginning AR verses current AR. Performs audits of both front and back office billing operation and makes recommendations to maximize performance. Designs and implements quality assurance programs to correct inefficiencies uncovered during the audits. Develops audits for monitoring service and financial activity. Updates and maintains directory of Medicare, Medicaid, and Workers Compensation fee schedules. Performs other related duties as assigned. **Senior Account Administrator - Business Office - Payment Posting Unit Grade 5 Job Description: Processes all EDI (Electronic Data Interchange) files for all PO practices, non PO, community network physicians and NYDH physicians via the Practice Management systems remittance receipts activities. Processes bulk payment 835 remit files such as Medicare, Medicaid, Medicaid Managed Care, Oxford, Empire BCBS, Horizon, United Health Care, Cigna and Aetna, as well as all additional carriers under testing. Resolves all edits for items that error out or do not post electronically for printing the EDI remittance advice reports and all related documents supporting the file. Prepares the reconciliation spreadsheet to ensure file is balance to the deposit amount. Researches, analyzes and trouble-shoots offset and recouping amounts. Properly posts, adjusts and documents accounts. Utilizes various online resources and system applications to obtain substitute explanation of benefits addition; and utilizes the secondary bank application to assist in reviewing and balancing payments received. Posts and documents all correspondence received via all assigned Lock Boxes within the bank application. Takes appropriate action, adjustments, write-offs and makes correction as needed. Utilizes the rejection dictionary to appropriately document the denial/ rejection or message on account. Additionally documents electronic notes in the banks application as required for all affected research criteria set up for all departments to re-direct correspondence as needed. Performs Payment Posting activities for all PO practices and other departments and physician networks not directly managed by the PO. Processes all payment types including; Medicare, Medicaid, Medicaid Manage Care, Manage Care plans, Commercial, Union, No Fault & Workers Compensation Insurance, Collection Agency, Insurance Carrier Settlements, Wire Transfers, Special Projects, Research Grants, Transplant Evaluation and other Global Package payments, and Credit Cards. In addition, processes all correspondence items received in the lockboxes via the bank browser. Verifies batch proof for accuracy; reads and interprets transactional data within accounts, decides appropriate adjustment and financial class changes based on patients insurance, third party rules, federal regulations, departmental policies and physician instructions. Reconciles posting batches to daily Lockbox deposit totals, prepares reconciliation document for cross confirmation. Responsible for analyzing all credits created as a result of posting and/ or other adjustments. Reads and interprets transactional data within accounts, retrieve EOBs or related documents, investigates analyzes and resolves credit balances when appropriate. Identifies documents and prepares all necessary documents needed to assist credit resolution and appropriately forward to the refund unit. Processes lockbox payments, split group payments, Research Grant, Transplant evaluation and insurance contract settlement payments and unapplied payments from other departments. Assists in researching and processing unapplied checks, misdirected payments and returned/stop payment checks. Sorts and processes incoming correspondence to various divisions within the Business Office as well as various departments within the Institution. Files and retrieves documents as needed. Participates in the periodic archiving process in the PO Posting Unit. Maintains specific insurance carrier reconciliation logs on a MS Excel spreadsheet to track checks/EFT payments, and remit posting information, as well as resolve payment offsets/retraction discrepancies. Verifies, uploads and exports deposit data of electronic funds transfer payments via the various bank applications and maintain depository logs. Utilizes depository logs to report file discrepancies, file processing issues, monitor payment patterns and articulate to management problems found. Research errors, inconsistencies and resolves by making necessary adjustments. Reviews and analyzes credits on accounts as a result of the remit posting and performs appropriate corrective action. Responsible for notating and reporting bank issues, scanning errors and inconsistent invalid trends found in the assigned Lock Boxes within the bank application. Reports issues with auto posting of electronic remit files. Processes Barcode/Scancode self-pay lockbox files across multiple departments. Post and resolve edit list via the excel spreadsheets. Research and analyze accounts for proper payment application. Reconcile the selfpay auto posting file to GE_IDX posting batches and the bank applications bank batches to finalize and confirm posting and deposit are in balance. Prepare reconciliation document and file in appropriate folder to validate posting. Processes Credit Card authorizations received within the Barcode Lock Box via the GE_IDX Credit Card Module. Reconciles authorized entries against the Trust Commerce Report received from the vendor. Appropriately notates bank application with posting status/exceptions. Performs appropriate credit card transfers across multiple departments and invoices for bulk credit card payments.
Posted on: Sun, 16 Mar 2014 10:11:46 +0000