Houston Methodist Supervisor of Billing in Katy, Texas
The Billing Supervisor (Supervisor) for the Centralized Business Office (CBO) is responsible for supporting billing of commercial and government payers as well as supporing the collection efforts for traditional Medicare and Medicaid. The billing process includes claim generation, edit/exceptions review/correction, claim validation in claim scrubbers, transmission to the clearinghouse, and processing of clearinghouse rejections and applicable reports. The insurance collection process includes initial payment, payment validation whether over or under paid, appeal/overturn denied claims, and credit balance resolution. The Supervisor will work with the commercial and government billing managers to ensure key performance indicators (KPIs) meet departmental goals. KPIs include billing WIP, days in AR, AR greater than 90 days, cash collections compared to goal, denial recovery rate, avoidable write-offs, days in credit balance, and others. The incumbant acts as a Project Manager at times. The Supervisor manages the electronic data interface (EDI) and all related information technology interfaces (through FTP or automated script) between the host system, billing software, clearinghouse, and Houston Methodist. This includes mananging the daily file transmittal, file reconciliation, file rejections, and ensuring the billing staff clear rejections processed by the clearing house. Additionally, the Supervisor will be required to fully support the system's billing software (McKesson Claims Administrator, Emdeon's Claims Master, and Epic) and management of customized edits, testing of new edits, testing and managing updates from the Software vendor or governmental, and assist in maintaining documents for change control. The Supervisor manages the Senior Claims Analyst and Charge Compliance staff and provides financial reports to the director and managers to maintain departmental functions and related reporting. Supervision of the Sr. Claims Analyst and Charge Compliance staff includes participating in hiring and disciplinary decisions, and accountability for defined expectations. The Supervisor also supports the Managers and Director by ensuring the staff have all tools and skills to be successful, and all reports are completed timely for departmental core functions and reporting.
PATIENT AGE GROUP SERVED
DUTIES AND RESPONSIBILITIES
PEOPLE - 10%
Engages customers and staff for the purpose of extracting discussion, ideas, opinions, and general contribution in individual settings, meetings, or to lead process improvements related to insurance recievable and all billing work in progress (WIP).
The Supervisor is responsible for developing and maintaining strong relationships with Information Technology (IT), billing & clearing house vendors (McKesson, Relay Health, Emdeon), Revenue Cycle Management, and Financial Accounting.
Create and maintain positive working relationships with end users and key stakeholders to ensure bi-lateral communication of issues/concerns are appropriately addressed and analyzed. Supervisor should take the lead role in providing education to key stakeholders.
Assists Manager by provides weekly productivity data and monthly quality reviews to billing staff. Assists in helping staff meet productivity and quality goals.
Mentors other team members with one on one training when needed.
Models performance expectations of excellence. Maintains appropriate professional boundaries. Communicates to staff in a clear, effective, and timely manner. Avoids talking to staff and peers when upset and agitated. Demonstrates behavior which sets the example for the staff to follow.
Creates and maintains positive working relationships with CBO key stakeholders (Patient Acces, HIM, Case Management, IT, etc.) to ensure bilateral communication of issues/concerns are appropriately addressed and analyzed.
Assists and supports Revenue Cycle team at each entity as it relates to resolving government receivable and reducing billing WIP by providing appropriate data.
Responsible for identifying, raising, and facilitating resolution of issues related to government receivable and billing WIP that arise during the course of normal business office functions.
Works with and partners with other Central Business Office (CBO) Managers to ensure consistency in execution of directives from Director.
QUALITY/SAFETY - 35%
Ensures that all claims are transmitted to the clearing house timely and daily. Guarantees all transmittals are appropriately reconciled and balanced daily. Reports out and manages transmittal issues directly with the clearing house partner and local Methodist IT partners. Escalates issues to Billing Manager or Director as needed.
Maintains Billing software as a system administrator, including managing new user requests, maintaining department user profiles, edit development, maintenance, upgrades/updates, and daily operational controls, to ensure billing output is accurate. Partners with and follows Methodist IT security guidelines and principles on all software directly supported.
Develops and documents business case/scope/plan, business/functional requirements as needed and presents to Director.
Develops proposed technical solution logic as well as facilitates discussions between the various technical groups, i.e. developers, DBAs, network services, billing vendors, and IT support, etc.
Develops detailed system test plans, executes system test cases and provides issue tracking and consolidation post production and/or go live.
Functions in a lead role to coordinate testing, auditing, and implementation of changes and upgrades to all billing systems. Partners with and resolves technical, customer, or vendor issues making changes and corrections as needed and coordinating communication of changes to departmental staff and customers.
Benchmarks current departmental data and works with staff to reach or exceed benchmarks as delegated by Manager.
Creates applicable tools and reports to define problems, collect and validate data, establish facts, and draw effective conclusions related to trends identified in receivables and billing WIP.
Executes weekly, monthly, quarterly, and yearly close processes as delegated by Manager or Director. This includes, ensuring vendor partners report all WIP has been resolved weekly, monthly credit balance reports are completed by staff, Medicare credit balance report is submitted timely, and automated adjustments are submitted to IT timely, etc.
Maintains, updates, develops, and enhances cash posting automated logic for government recievable to accurate posting and daily operational needs are maximized. Continuously ensures automated postings are working as intended to avoid outdated/incorrect postings.
FINANCE - 35%
Supports Manager in assisting in meeting Director's goals which includes being held accountable to unit's key performance metrics, and providing supervisory support to billing and follow up staff.
Works closely with vendor partners to ensure their operations support the Director's goals and KPIs. Supervisor will review and approve monies recovered by vendor for accuracy and appropriateness. Supervisor may also provide reports for managing vendor performance.
Works with either billing or follow up manager to provide applicable reporting on avoidable write offs and unnecessary denials. This includes identifying and analyzing rejections, RTPs, medical necessity, denials, zero pays, etc., for trends and opportunities.
Perform/Provide analysis of Billing (Claims Administrator/Claims Master/Epic) and Clearing house (Relay Health / Emdeon) output to assist operational decision making. This may include running standard and ad hoc reports as needed, meeting with vendor's representatives, providing trend data, metrics, etc.
Generates productivity, quality, and inventory data and applicable reporting to monitor and report on personnel and departmental efficiency. Reports results of key performance metrics to Government Director or Manager on a timely basis.
Actively monitors CMS, TMHP, and Managed Care Contract & Payer updates/alerts/releases and works with manager to implement appropriate operational changes to accommodate new state and federal billing rules and practices. Includes communicating updates to key stakeholders as needed.
GROWTH/INNOVATION - 10%
Seek ways to optimize cash collections and streamline operations throughout the CBO.
Responsible for continuously seeking to develop improved analytic metrics that foster the improvement of all applicable billing systems (McKesson Claims Administrator - legacy, Emdeon Claims Master, and Epic Billing systems) in order to take full advantage of industry automation and electronic enhancements.
Participates in Revenue Cycle forums and is seen as a subject matter expert. Attends local industry luncheons, seminars. Actively seeks education in the healthcare sector.
Actively seeks continued education and personal growth related to leadership and management.
This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.
Associate's Degree in science, finance, healthcare, related field or equivalent college hours preferred.
Five or more years of applicable supervisory and personnel supervision experience in hospital AR, with a thorough understanding of hospital and facilty billing, government reimbursement and collections required.
Experience with hospital enterprise billing (multi-facility) a strongly preferred.
Knowledge of front-end Patient Access processes and work flow.
4-8 years experience working with computer systems, including Microsoft Professional Suite, Medicare DDE/FISS, and hospital billing systems (SSI, Meditech, Claims Administrator, Claims Master, etc.)
Coding knowledge is a strong plus including familiratiy of ICD-9-CM/ICD-10, CPT/HCPCS.
Experience in working with information technology on development projects preferred.
Experience with Microsoft Analysis applications a plus.
Epic certification in HB Billing a plus.
Six Sigma designation a plus.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Strong financial analysis skills, experienced in pulling and reconciling data and creating reports
Strong analytical and problem solving skills
Strong communication and interpersonal skills
Ability to work under pressure and balance many competing priorities
Proficient in spreadsheet, word-processing and presentation software
Ability to support teamwork and maintain a positive and supportive attitude.
Professional handling of exposure to confidential/sensitive information
Proven and demonstrated leadership skills
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Houston Methodist (HM) is one of the nation’s leading health systems and academic medical centers. HM consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston metropolitan area. HM also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, HM employs over 25,000 employees. Houston Methodist is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide the best patient care and service in a spiritual environment.
In 2019 Houston Methodist and its physicians treat more than 6,333 international patients from more than 76 countries. Houston Methodist Global Health Care Services’ consulting and education divisions also provide advisory services and training and development to health care organizations around the world.
Street: 701 S Fry Road
Name: Corp Rev Cycle - A/R
Regular Shift: 1st - Day