Northwell Health Mgr Business (FPP) in New Hyde Park, New York

Req Number 001S8D

Job Category Finance

Job Description

As Business Manager FPP you will support revenue cycle operations of the clinical department by providing expertise in front-end best practice operations, oversee billing and collection of monies generated from physician's services and ensures adequate communication of financial and operational results, perform fee schedule analysis and oversees managed care contracting and related activities for the department/division and support revenue cycle functions, Quality and Service Excellence initiatives .

Responsibilities Include:

  • Manages department/division in a fiscally responsible manner:

  • Assists in preparation and monitoring of annual operational, personnel and capital budgets.

  • Monitors budgetary variances and progress in budget revenue performance and communicates to Department and Administration.

  • Oversees billing and collection of monies generated from physician's services:

  • Develops and prepares variety of automated reports which may include augmentation projections, statistical and financial analysis and narratives.

  • Monitors financial performance of existing programs through the development of P&L statements, various reports and financial analyses, as required. Projects profitability/risk of new programs through the development of business plans and pro formas.

  • Compiles statistics on a daily and monthly basis and prepares various statistical and budgetary reports (procedure billing, aging trail balances, total accounts receivable, total revenue).

  • Reviews and recommends improvements for financial management of each billing area.

  • Performs periodic and year-end account analysis as necessary.

  • Acts as a resource person for resolution of complex billing situations.

  • Performs revenue cycle management:

  • Working with Departmental Administrator and Business Managers, analyzes and improves the performance of front-end billing operations through development and monitoring of performance criteria related to:

  • Front end patient data acquisition and management;

  • Appointment scheduling, patient registration, insurance verification, data entry, charge and diagnosis assignment and charge capture activities;

  • Front-end billing operations key indicators, including denial trending analyses and co-pay collection;

  • Error reports, claim processing reports, accounts receivable reports and any pertinent ad hoc reports.

  • Identifies problems in the process flow or organizational structure that impedes financial outcomes, proposes solutions and collaborates with department to implement corrective action, including:

  • Allocation of resources related to front end functions;

  • Training of front end staff related to key revenue cycle functions;

  • Availability and use of technology and automated tools that support revenue initiatives;

  • Enforcement or revision of policies and procedures.

  • Trains and supervises personnel in billing aspects of accounts receivable activities.

  • Performs revenue management for the department.

  • Assists in development of annual revenue projections for the department.

  • Monitors the current monthly revenues and communicates results through variance reports. Reviews financial performance through P&L statements, AR analysis and other reports.

  • Analyzes variances and identifies opportunities for improved results.

  • Performs fee schedule analysis.

  • Analyzes the fee structure of the particular division and provides semi-annual fee and revenue reassessment.

  • Proposes fee structure revisions based on local, regional and tertiary fair market pricing assessments and opportunities for net revenue improvement.

  • Supports new program development by advising on development of fee arrangements for new or special services.

  • Monitors accuracy of fee structure and reimbursement payment schedules from third party payors, all cash payment deposits and refunds.

  • Oversees managed care contracting and related activities for department/ division.

  • Responsible for the enrollment and credentialing of physicians in managed care plans.

  • Analyzes current managed care contracts for the clinical department and assesses the financial impact on the practice. Proposes modifications and other pertinent strategies, including plan participation, as necessary.

  • Analyzes billing administration of third party payment contracts to ensure correct billing, adjudication and payment processing and result reporting. Serves as a liaison to the FPP billing operations to resolve payment and other receivable issues.

  • Collaboratively with the Managed Care Contracting department performs audits and reviews, proposes and/or negotiates payer contract revisions and communicates the financial impact to the Chair and Division Chiefs.

  • Serves as a liaison to central FPP office and monitors the credentialing process and plan participation status with third party payors for new and existing physicians. Confirms appropriate profiling with IDX billing system.

  • Performs reimbursement management.

  • Analyzes payor reimbursement to ensure proper claims adjudication.

  • Monitors payment denials, reductions and rejections to determine operational or coding problems.

  • Manages write-offs, adjust downs, bad debts and other delinquent accounts.

  • Initiates CPT-4 analysis, per provider, to determine shifts in services and payor mix.

  • Assists with development of charge documents (superbills, encounter forms, PDA formats), to ensure appropriate selection and reporting of services in compliance with coding protocols, AMA and federal guidelines and HIPAA requirements.

  • Ensures proper in-services on CPT-4/ICD-9 coding regulations.

  • Negotiates contracts for outstanding accounts with collection agencies.

  • Responsible for ensuring that key revenue cycle functions are handled in an accurate and timely manner.

  • Responsible for ensuring key revenue cycle functions, including but not limited to: scheduling, verification of insurance and demographic information, co-pay collection, charge capture and referral management are handled in an accurate and timely manner.

  • Ensures the adequate communication of financial and operational results.

  • Responsible for overseeing daily operations and for managing all non-clinical personnel in the division and all related areas.

  • Hires, trains, disciplines and supervises staff. Evaluates performance and ensures efficiency in their roles. Completes appraisals on a timely basis.

  • Oversees scheduling (vacation, holidays) and ensures adequate coverage at all times. Performs related personnel functions.

  • Assists in developing and maintaining objectives, policies and procedures to ensure the efficient operation of the department/division.

  • Strives to streamline operations and effectively apply new concepts and techniques for positive outcomes. Identifies and implements technology to improve operations.

  • Ensures adequate communication of financial and operational results to staff.

  • Ensures proper in-services on CPT-4/ICD-9 coding regulations.

  • Coordinates and oversees the resources of multiple administrative disciplines/ functions.

  • Routinely monitors program performance per volumes, referrals and trends.

  • Collaborates with FPP to optimize billing practices and collection of Part B revenues.

  • Keeps abreast of billing, coding and reimbursement related issues as they apply to the division and facilitates staff education in regard to these changes.

  • Structures the appropriate flow of data to insure timely and appropriate management of clinical and financial issues, which may comprise patient care in the department.

  • Establishes and maintains a working relationship with the physician staff with respect to their compliance and performance related to billing, coding and regulatory agency standards.

  • Ensures the continual efficient and compliant operational performance of the department/division.

  • Ensures department/division staff adheres to system Corporate Compliance Program, HIPAA regulations and all other regulatory standards.

  • Ensures compliance with regulatory agency standards. Supports Quality initiatives.

Qualifications

  • Bachelor's Degree in Business Administration, Management or related field, required. MBA or related degree, preferred.

  • Minimum of three (3) years progressively responsible related work experience to ensure familiarity with third-party reimbursement and billing systems, financial management of a medical practice, budget preparation, and automated report generation.

  • Thorough understanding of managed care issues, required.

Our Culture

Transforming care, optimizing patient satisfaction and creating better patient outcomes are just some of the things our talented team members are doing at North Shore-LIJ each and every day. As a culture committed to providing our customers with the highest quality service, we stand behind our core values: Patients first; Caring; Excellence; Innovation; Integrity and Teamwork. It is our commitment and our culture that sets us apart from others and is the cornerstone of everything we do. Join an organization whose team members are valued, cared for and offered continuous opportunities to grow. Click on the link to learn more about us: www.northshorelij.com/goals

Please note: North Shore-LIJ is a smoke-free environment. Smoking and the use of tobacco products is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises. Free smoking cessation programs and quit medications are offered to team members who wish to quit through the North Shore-LIJ Center for Tobacco Control.