Covenant Health

Patient Accounting Manager, CMG Business Office

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.

Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer. 

Position Summary: 

Provides daily leadership to Insurance Follow-Up & Financial Posting personnel to ensure that all duties are performed accurately and efficiently.  The Insurance Follow-Up & Financial Posting Manager monitors all functions of the department and maintains equipment/software, i.e. table files, to ensure promptness and efficiency of all follow-up duties.  Supervises the Patient Account Representatives and Supervisors on a daily basis. Recruits, selects, develops and motivates a competent staff to insure the continuance of productivity and positive morale. This position assists the department Director and the Vice President in establishing and meeting strategic goals and outcomes for the Consolidated Business Office (CBO).  The CBO provides Patient Accounting functions for multiple facilities and entities which requires a working knowledge of several service lines and payer requirements.

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

Integrity

• Maintains accountability for the Insurance Follow-Up and Financial Posting Units, and ensure that expectations are consistently met and that accounts are handled in a timely manner.
• Establishes team-based goals and success measurements for the Insurance Follow-Up and Financial Posting Units. Identifies team contributions that meet established goals and areas of opportunity. 
• Provides the motivation and incentive necessary for acceptable productivity from the Follow-Up and Financial Posting Units.
• Monitors performances at least monthly, and identifies variances to established targets.
• Demonstrates knowledge of State and Federal regulations, privacy laws, HCFA guidelines, TennCare guidelines and other Third Party Payor requirements assuring departmental collection
• Ability to identify and review problem accounts to determine reason(s) for and resolution of problems soliciting input when required from outside resources, and delegates to staff for follow-up.
• Recognizes situations, which necessitate supervision and guidance, seeks appropriate resources.
• Does not promote or participate in solicitation during working hours within the department.
• Accepts total responsibility for the work performance of the Insurance Follow-Up and Financial Posting Units
• Supports, models and adheres to the desired behaviors of the KBOS Constitution for integrity which are; hold others accountable for living the values and behaviors, protect confidential information, deal with difficult issues honestly, directly, and respectfully, and tell the truth.

Quality

• Supervises the submission of daily claims to ensure the timely and accurate billing of inpatient, outpatient, and ER accounts while maintaining follow-up procedures to secure necessary supporting documentation for suspended/pended claims.
• Ensures that cross training is incorporated into the billing area so that staff is knowledgeable of multiple payor requirements and billing guidelines.
• Maintains equipment/software, i.e. table files, for the Billing department.
• Provides leadership to the billing area, including but not limited to hiring, training, disciplinary actions, evaluations, establishment of work priorities, and other daily operational duties.
• Proficiently maintains and processes employee time cards and attendance records.
• Professionally deals with patients, physicians, public, and other management personnel concerning Billing matters.
• Trains new personnel in areas of responsibilities and provides in-service education for existing personnel on new policy and procedures as developed.
• Prepares performance evaluations on a timely basis and reviews same with the Director for concurrence.
• Involves and monitors staff participation in departmental Balanced Score Card goals on an ongoing basis.
• Monitors the creation, maintenance, and distribution of all required documents and statistical reports related to Billing productivity.
• Establishes and maintains Billing procedures staying current on industry trends to ensure ability to transition the Billing department for necessary and future billing regulations.
• Establishes and adheres to policies and procedures in an effort to assist employees in job performance and to provide for internal controls within the Billing area.
• Distributes HCFA memos to Billing staff and provides training for new or revised rules ensuring compliance with HCFA, Tenncare/Medicaid or other State or Federal regulations.
• Searches for innovative ways to identify opportunities for improving the billing process.
• Maintains Biller statistics regarding the number of claims and dollar amount of accounts billed, rebilled and suspended for the purpose of productivity monitoring allowing for the identification of training needs, competency levels, etc.
• Performs other duties as assigned to the satisfaction of the Director of Patient Accounting.

Service

• Communicates effectively with patients/public, co-workers, physicians and/or their offices, and other hospital personnel using verbal, nonverbal, and written communication skills.
• Consults and works collaboratively with supervisors, co-workers, department Director, and other hospital personnel, effectively performing tasks of position.
• Independently monitors work performed, periodically talking with customers and spot checking accounts and other reports to insure accuracy/timeliness of billing and patient satisfaction.
• Trains and monitors all staff in regards to customer relations to insure total responsiveness and sensitivity to customer needs.
• Assists the Reimbursement Unit to resolve payment and contractual issues.
• Assists Vice President, Director and Managers on activities and projects, as needed.
• Assists with the development of staff communication, Balanced Score Card goals and other objectives that take into consideration the mission and values of Covenant Health.

Caring

• Maintains lines of communications with other department managers in an ongoing effort to improve the overall quality of customer service.
• Promotes good public relations for the department and the hospital adhering to desired behaviors.
• Participates freely in intradepartmental quality improvement activities whenever called upon to do so.
• Develops and implements annual plan for improving customer satisfaction regarding the Billing process.

Developing People

• Holds monthly meetings with staff and coordinates discussion regarding work performance and department/hospital updates.
• Provides education that will prepare staff for the most efficient use of their computer systems; support creativity and innovation to foster individuals’ empowerment; remain flexible and proactive toward changes within the healthcare industry and customer needs.
• Determines training and development needs of billing staff to enhance professional growth, satisfaction and performance.  Responsible for individual and team training related to the computer system, upgrades, regulatory changes, insurance requirements, etc.

Using Resources Wisely

• Demonstrates the ability to effectively manage the resources of the organization by managing salary and supply costs within, or below, the operating budget. Uses innovative approaches for optimal staffing and expense reductions.
• Demonstrates promptness in reporting for and completing work ensuring follow-through on assigned tasks.
• Demonstrates initiative in increasing skills, and attends training programs as available.
• Provides assistance to new employees.
• Attends In-Service as scheduled.
• Recommends to the Director, new policies and updates to existing policies that are intended to increase efficiency and promote data integrity.
• Follows protocols as established by the department.

Minimum Education:

College graduate with degree in finance, accounting, or business/management preferred.  High school with experience equivalent to degree may be considered.  Good working knowledge of healthcare billing, Medicare/Medicaid billing guidelines and other Third Party Payor rules and regulations.

Minimum Experience: 

Three (3) to five (5) years experience in health care preferred.  Experience in problem solving, analytical reviews, budgeting, and forecasting preferred.  Knowledge of third party payors and hospital billing software required.  Must possess a knowledge of claims submission process for all major carriers and intermediaries, knowledge of third party reimbursement with working knowledge of Network/Managed Care issues, and a general understanding of bankruptcy law, credit and collection act.  Demonstrates the ability to handle varying tasks as well as understanding and interpreting procedures relative to the billing process.  Expected to perform adequately within the position after working at lest three (3) to six (6) months on the job.

Licensure Requirement: 

None