Revenue Cycle Manager

Department Overview

OHSU Neurological Surgery maintains dedicated programs in brain, skull base, and pituitary tumors, spinal surgery, vascular neurosurgery, movement disorders, epilepsy, facial pain, complex spinal and cancer pain, pediatric neurosurgery, craniofacial disorders, hydrocephalus, spina bifida, spasticity, peripheral nerve disorders, and nervous system trauma.

Reporting to the Administrative Director, this position manages the clinical revenue cycle in support of department professional services including front and back ending billing functions, compliance and coding activities. This includes the adult and pediatric operating rooms and associated outpatient clinics. This role is integral to financial performance and anticipates trends in funding and financial healthcare, developing productivity and statistical reports and working with faculty to resolve billing and documentation problems. Responsible for relations with other hospital departments and both internal and external business associates and supervises all billing staff. Develops and maintains processes that support full recovery of all professional fees. Collaborates with OHSU revenue cycle departments to expand knowledge of reimbursement practices. Monitors front end process to ensure all services provided are billed and accurately completed in conjunction with OHSU and UMG guidelines. Coordinates the department's referral authorization process towards the goal of all authorizations confirmed prior to an outpatient appointment or surgical procedure. Provides support and guidance regarding financial policies and monitors payment receipt. Develops continuing education sessions for staff and department faculty to ensure accurate billing procedures. This position supports these functions in the Department of Neurological Surgery and provides approximately .10 FTE support to the Department of Interventional Radiology, under the oversight of the Vice Chair for Administration.

This position performs in a manner which maintains the confidentiality and privacy of each patient, promotes teamwork, cooperation and a positive service attitude. Supports and adheres to the Code of Conduct and Policies and Procedures of both OHSU hospital and clinics and the Department; models ethical and appropriate behavior, professional standards, compliance and personal integrity.

Function/Duties of Position

Revenue Cycle Oversight: Responsible for oversight and management of internal and external billing processes. Monitors tracking systems in Epic and open charts in EpicCare to ensure all patient encounters generate a charge.  Reviews and releases all clinic charge sessions in work queues. Reconciles the surgery schedule to ensure all surgical charges are entered.  Responsible for reviewing and acting on all denials in work queues, coordinating issues with coder, schedulers and managed care coordinators. Develops and uses methods for comparing actual reimbursement to expected reimbursement.  Takes action to resolve discrepancies and to increase reimbursement in a timely manner. Summarizes trends for management. Acquires and maintains basic knowledge of procedural and diagnostic coding. Maintains specific competency in office-based coding. Attends OHSU meetings/seminars related to coding and compliance topics.  Represents the department at Hospital & Clinics Managed Care meetings. Aligns authorization processes and procedures to meet department objectives. Collaborating with OHSU revenue cycle departments, monitors, develops and refines procedures and practices intended to collect fees due from third party payors and/or responsible individual(s). Compiles accounts receivable and encounters data as required for decision support. 

Regulatory Compliance Accountability: Responsible for specialty specific compliance expertise. Keeps abreast of regulatory changes and researches documentation and compliance issues. Provides ongoing group and individual training for all clinicians (MD, CRNA, NP, PA) as well as residents and fellows as required to ensure compliance with CMS, DNV, and other regulatory agencies. Shares responsibility with the departmental HIPAA and Compliance Officer, acting as liaison with other compliance and departments and representatives at OHSU.

Reporting and problem-solving: Responsible for developing reports from the billing data that track productivity, payor mix, specialty services, and revenue information. Compiles and formats various views of the billing and collection cycle to illustrate the effects of AR drivers: registration, check in verification, authorization, scheduling, coding, reimbursement, cash application and appeals. Prepares monthly and annual reports to present to department leadership and makes recommendations to improve performance. Works closely with Administrative leadership, Chair and clinical directors to address clinical issues in a timely and proactive manner. Generates ad hoc and monthly report from multiple data systems. This includes revenue reporting, detailed accounts receivable analysis, and requests for custom analysis by the physicians, residents, administrator, and research staff.

Support Staff and Faculty Education: Orients all staff: clerical, residents and faculty to the basics of health insurance, purpose of coding systems, Medicare & Medicaid requirements, auto insurance, workers compensation & disability. Provides specific instructions concerning position responsibility for coverage & benefit eligibility, authorization, disability verification and legal billing. Educates department scheduling & registration staff about types of insurance coverage, methods of payments and eligibility/authorization requirements. Directly supervises one employee and indirectly supervises seven others related to billing/coding.

Additional leadership: participate in department leadership activities and maintain strong connection to central leadership team. 

Required Qualifications

• Bachelor’s degree in relevant field or equivalent years of education, training, and experience
• 4 years’ experience in medical billing office or medical operations that included hands-on billing and collection and patient contact. 
• 2 years of supervisory/managerial experience.
• Experience in medical billing office with ICD 9 and CPT coding. 
• Experience in multiple aspects of medical/surgical practice policies/procedures
• Knowledge of surgical billing, coding and claims cycle.  Conversant with spreadsheet applications. 
• Able to compose policy and procedure documents. 
• Effectively presents concepts and instructions in written & verbal forms. 
• Knowledge of OHSU billing systems, A2K, LCR, FMS preferred. 
• Strong analytical and organizational skills; ability to manage large quantities of data required.
• Ability to perform the job duties with or without accommodation.

Preferred Qualifications

• Knowledge of Neurosurgical billing, coding, and claims cycle.
• Three or more years of experience in medical billing office with ICD 9 and CPT coding. 

Why apply to OHSU?

We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact [email protected]