Job Description

Position Details

Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Level 2 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.

Active - Benefit Eligible and Accrues Time Off

Work Hours per Biweekly Pay Period: 0.00

Shift : Monday - Friday

Location : 210 South Florida Avenue Lakeland, FL

Pay Rate : Min $73,985.60 Mid $92,476.80

Position Summary

The successful candidate will be responsible for providing the daily management of the Ambulatory A/R for the Revenue Cycle Operations team; coordinating functions with other departments; optimizing staff performance through process redesign, policy/procedure implementation, communications and outcome feedback; attending managerial meetings as a representative of the department, providing orientation, training and continuing education for all staff; plus all related job duties as assigned.

Manages the follow-up and denials team on all medical billing and claims activity initiated within a centralized business office. Responsible for thoroughly managing assigned claims and orders with accuracy and on a timely basis for achieving the appropriate reimbursement for services rendered. Identifies and facilitates opportunities for improvement in the areas of quality care and services, stewardship, employee satisfaction, communication, accountability and customer satisfaction.

Position Responsibilities

People At The Heart Of All That We Do

• Fosters an inclusive and engaged environment through teamwork and collaboration.
• Ensures patients and families have the best possible experiences across the continuum of care.
• Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement

• Behaves in a mindful manner focused on self, patient, visitor, and team safety.
• Demonstrates accountability and commitment to quality work.
• Participates actively in process improvement and adoption of standard work.

Stewardship

• Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
• Knows and adheres to organizational and department policies and procedures.

Manager Capabilities

• Demonstrates accountability for overall departmental operations and/or organization-wide functional responsibilities within the system to support achievement of organizational priorities.
• Coaches team leaders, direct reports and team members to create a productive work environment.
• Creates a high performing team by building strong relationships, mobilizing others to action and effectively leveraging the talent of their team.
• Manages and supports conflict/issues resolution implementing appropriate corrective actions, improvement plans and regular performance evaluations.
• Demonstrates capacity to manage change resistance and break down barriers to effective improvement and transformation.
• Serves as a mentor for a healthy and safe culture to advance system, department and service experience.

Standard Work Duties: LRHPG Revenue Cycle Manager

• Responsible for the operations management of the Revenue Cycle Operations department, which includes billing and follow-up/denials. Responsible for developing a system to prioritize follow up work based on payer mix, dollar amount (in descending order), to be done date, & aged A/R. Expectation to reduce AR>90 to less than 20% for insurance AR.
• Ensures cash optimization and accounts receivable reduction activity is functioning to fullest capability. Maximize technology use for timely productivity on claims follow-up, payment posting and status review.
• Utilizes previous experience in adjudication of bills, and accounts receivable functions. Resolves billing and collection issues. Manages resubmissions of denials and ensures that department is maximizing reimbursement to efficiently lower A/R and speed up revenue cycle. Follows set guidelines for the appeals process set by payers, and ensures that claims are contested on a timely manner.
• Responsible for preparing denials reports and presenting to Clinic Managers and Directors to reduce future denials and improve work flows.
• Works collaboratively and takes a proactive approach to communicate errors to the appropriate staff, clinics, physicians, and other Management as necessary.
• Responsible for performing annual reviews on staff based on the guidelines and timelines set by the organization.
• Adheres to compliance and departmental policies and procedures including compliance with 100% of HIPAA requirements, required training, and other health system mandated activities
• Works independently, take initiative, and think critically.
• Knows and adheres to organizational and department policies and procedures.

Competencies & Skills

Essential:

• Demonstrates knowledge of the Reimbursement Appeals & Denials policies and procedures & possess the ability to articulate such functions.
• Strong leadership and coaching/staff development skills.
• Knowledge of Commercial and Supplemental collection policies and procedures, Managed Care Contracts and contracting, and Government regulatory guidelines for referrals, authorizations, billing and follow up.
• Strong written and verbal communication skills.
• High degree of self-motivation, commitment and integrity.

Qualifications & Experience

Essential:

• Bachelor Degree

Nonessential:

• Master Degree

Essential:

• Business Administration, healthcare administration or other related fields

Other information:

Experience Essential:

- 5+ years in a professional role with increased leadership responsibility.

- Specific experience with hospital and doctor's business office processes.

Certifications Preferred:

- Advanced Certification from HFMA/MGMA or other related healthcare professional organization

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