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Oversee day-to-day billing operations for hospital and professional (HB/PB) services, ensuring accurate, timely, and compliant claim production and submission. This role ensures accurate, timely, and compliant claim production and submission, drives clean-claim performance and first-pass acceptance, accelerates cash, reduces billing-driven denials and avoidable write-offs, and operationalizes standardized workflows, controls, and performance management across facilities and service lines.
Qualifications
• Education: Associate degree in Healthcare Administration, Healthcare Management, or a related field highly preferred.
• Experience: Minimum of 3 to 4 years of progressive revenue cycle experience, including at least 1 to 2 years in billing operations (HB and/or PB) within a hospital or multi-site health system with a two-year degree.
• Minimum of 3 years of supervisory experience in hospital and/or professional billing operations.
• A formal degree may be substituted with 6+ years of direct, hands-on revenue cycle and supervisory experience.
• Demonstrated experience with Epic and revenue cycle technologies.
• Proven success leading teams through organizational change and process improvement initiatives.
• License/Certification/Registration: Not required.
• Deep knowledge of:
- Hospital Billing (HB) and Professional Billing (PB) workflows
- Payer billing rules and regulations
- UB-04 and CMS-1500 claim forms
- NCCI edits
- Medically Unlikely Edits (MUEs)
- Local Coverage Determinations (LCDs)
- National Coverage Determinations (NCDs)
- Timely filing requirements
• Strong operational leadership and performance management discipline, including:
- Key Performance Indicators (KPIs)
- Operational cadence
- Accountability measures
• Proven success in:
- Improving clean claim rates
- Increasing first-pass claim acceptance
- Reducing denials
- Lowering accounts receivable (A/R)
• Excellent communication, cross-functional collaboration, and stakeholder management skills.
• Demonstrated change leadership and a continuous improvement mindset, including experience implementing:
- Standardized operational playbooks
- Automation initiatives
- Process optimization strategies
• Strong analytical proficiency with reporting tools and the ability to translate data into actionable operational improvements.
• Working knowledge of:
- HIPAA privacy and compliance requirements
- Billing audit practices
- Revenue cycle regulatory expectations.
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