One of NC's largest health systems, recently ranked as the #1 Best Hospital in NC, and the region's only not-for-profit, independent community hospital system, Mission Health is fully committed to helping our community Be Well, Get Well and Stay Well.
Role Summary: The System Manager of Billing and Denials Services will provide leadership and oversight of the health system's team working hospital and professional claim denials. Provides guidance and direction to the operations and processes leading to the identification, prevention, reporting, and timely resolution of denials. The System Manager works closely with key stakeholders in the organization and external partners such as referring physicians and insurance companies to minimize the financial impact of claims denials.
The System Manager establishes and maintains hospital and physician billing system methods through project planning, in-depth analyses, program development and implementation. This position plans, develops, administers and coordinates all daily billing functions and denial resolution workflows for the efficient and compliant operations in accordance with all established Mission Health System policies and procedures. Ensures that the department is operating within approved budgetary constraints. Works with billing management to ensure yearly departmental goals and objectives are established as well as participate as a team member in meeting objectives and goals. This position will monitor denials, identify areas of opportunity, and implement self-sustaining changes to improve operational effectiveness and financial gain.The System Manager is primarily responsible for providing direction and oversight of the Billing and/or Denials Administration team while overseeing claim preparation, claim submission and billing edit functionality system wide. Provide functional guidance to subordinate billing and denials staff in supporting area operations and programs ensuring all billing/payer edits and reason/remark codes are continually updated. The System Manager will also maintain appropriate files, reports and other statistical data as required and provide results of all special projects and provide recommendations for additional revenue opportunities. The System Manager is responsible for keeping informed of new changes in billing regulations and denial resolution method. Resolving ways to work within any new regulation and coordinating any testing or move to production efforts as it applies to billing functions.
This position will serve as a subject matter expert and a technical resource by providing intra and inter- departmental support on billing systems and denial related issues. Maintains inter-department communications with all levels of personnel in order to define system requirements, streamline workflow to ensure a reduction in denials, set priorities, train system users and explain new concepts. The System Manager will work closely with all Revenue Cycle staff, system wide departmental leaders, patients and physicians. Direct interaction with all Managers and Department Heads regarding administrative issues related to rejections and/or denials. Coordinate activities with other departments and is expected to demonstrate, through plans and actions, that there is a consistent standard of excellence
Required Education: Bachelor's Degree and/or 10 years related work experience
Required License: CPC, CCS
Required Experience: Ten years of leadership experience in a directly related role. Computer skills including word processing, spreadsheets, Internet and Intranet software, e-mail. Thorough knowledge of Electronic Data Interchange (270/271, 276/277, 837, and 835 ANSI program transactions)
Preferred Experience: Database software, Strong knowledge of documentation requirements, National Correct Coding Initiative edits, LCDs, MUEs and physician/inpatient and outpatient hospital billing requirements.
Mission Health, based in Asheville, North Carolina, is the state’s sixth-largest health system and the region’s only not-for-profit, independent community hospital system governed and managed exclusively in western North Carolina. Mission Health was recognized as one of the nation’s Top 15 Health Systems from 2012-2015 by Truven Health Analytics, formerly Thomson Reuters, becoming the only health ...system in North Carolina to achieve this recognition. Mission Health, which traces its roots in the region back to 1885, operates six hospitals, numerous outpatient and surgery centers, post-acute care provider CarePartners, long-term acute care provider Asheville Specialty Hospital and the region’s only dedicated Level II trauma center. Its medical staff consists of more than 1,000 physicians and is certified in more than 50 medical specialties and sub-specialties. Mission Health has seven Centers of Excellence: Cancer, Heart, Mission Children’s Hospital, Neurosciences, Orthopedics, Trauma and Women’s Health. Mission Hospital, located in Asheville, is the system’s flagship hospital and is licensed for 763 beds. It is the regional referral center for tertiary and quaternary care. It also includes Mission Children’s Hospital – the region’s only children’s hospital. Other Mission Health member hospitals include Angel Medical Center in Franklin, Blue Ridge Regional Hospital in Spruce Pine, Highlands-Cashiers Hospital in Highlands, McDowell Hospital in Marion and Transylvania Regional Hospital in Brevard. With approximately 10,700 employees and 2,000 volunteers, Mission Health is dedicated to improving the health and wellness of the people of western North Carolina.