GENERAL SUMMARY AND PURPOSE:
Oversees the development, maintenance, and integrity of the SAMG Physician Fee Schedule with the objective of maximizing reimbursement under State, Federal and third party payer guidelines. Analyzes reimbursement trends and provides feedback and recommendations to finance and payer contracting. Performs trending and analysis of payer adjustments and denials.
Recommends system changes aimed at maximizing reimbursement and provides training to clinic and CBO staff as appropriate. Assists SAMG clinics in acquiring Provider Based designation based on CMS guidelines and assists Rural Health Clinics in compiling annual cost reports. Works closely with SAHS Revenue Integrity Officer to ensure compliance related to professional services. Provides leadership and direction to direct report staff members including the SAMG Coding Manager and the SAMG Float Pool Manager. Assist hospital to ensure compliance with TJC (The Joint Commission) requirements regarding CLIA (Clinical Laboratory Improvement Amendments) certification.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
Bachelor's degree or equivalent combination of education and experience specialized in physician revenue cycle management and operations required.
Minimum five years experience in physician fee schedule development and data analysis, in a health care setting, with strong background in finance and clinic operations.
Experience with Provider Based and Rural Health Clinic designation requirements.
ESSENTIAL FUNCTIONS
Develop and maintain SAMG physician fee schedule and SAMG Provider Based fee schedule in accordance with CMS guidelines. Conduct regular analysis and provide recommendation for annual increase.
a. Compare cost/reimbursement analysis for all lab, medication and supply codes to ensure integrity within fee structure and maximum reimbursement.
b. Establish analytic support tools to provide ongoing monitoring/management of fee schedule.
c. Perform analysis and trending of payer reimbursement based on contractual adjustment and claims denial.
Assist in development and maintenance of electronic tools within the Electronic Practice Management application.
Perform prospective modeling and retrospective analysis of Revenue Cycle trends, changes in payer policies, and targeted initiative impacts.
Assist SAMG practice locations acquiring Provider Based designation to comply with CMS guidelines and implementing operational processes.
Work closely with the Rural Health Clinics to ensure compliance and gather data for the preparation and submission of the annual cost report.
Assist hospital Lab Director to ensure SAMG clinic locations are in compliance with CLIA and TJC standards.
Work closely with SAHS Revenue Integrity Officer to ensure compliance related to professional services.
Maintains knowledge of all applicable Federal, State, and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Personnel Management: Responsible for recruiting, hiring, orienting, supervising, coaching, disciplining, engaging, developing, and evaluating performance for all staff. Utilizes effective leadership and management skills to inform and engage staff and maximize their potential-- communicating expectations, monitoring results and coaching for improvement. Work to continuously monitor and improve staff competence and effectiveness. Assists staff in developing skills and identifying staff educational needs.
Strong knowledge of health care revenue cycle and payer contracting.
Expert knowledge of State and Federal health care regulatory requirements.
Familiarity with the Nextgen Enterprise Practice Management system.
Excellent written and oral communication skills that provides effective interaction with all levels of management and staff.
Excellent organizational skills with the ability to prioritize and self manage.
Excellent analytical and problem-solving skills and ability to multi-task.
Ability to create and foster a cooperative team work environment.
Provide leadership and direction to direct report staff members.Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.