Revenue Cycle Supervisor

Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State. Sea Mar proudly serves all persons without regard to race, ethnicity, immigration status, gender, or sexual orientation, and regardless of ability to pay for services. Sea Mar's network of services includes more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services. We are recruiting for the following position:

Sea Mar is a mandatory COVID-19 and flu vaccine organization

Position Summary

This Position is responsible for managing special business office projects and assisting the Revenue Cycle Manager in supervising the day-to-day operations of the Central Business Office (CBO).

Duties and Responsibilities

As a mission-driven organization, the core values of, and the services offered at Sea Mar are based on the belief that everyone deserves to be respectfully treated in a way that preserves dignity and enhances self-worth. Sea Mar is an advocate for its clients and aims to achieve industry-leading, client-centered, culturally-aware services. 

Sea Mar employees serve as an extension of this mission and demonstrate their commitment to an excellent client experience by:

• Understanding and empathizing with client needs
• Surpassing client expectations
• Demonstrating a high level of integrity
• Exhibiting compassion and commitment
• Advocating for social justice
• Taking pride in individual work as well as that of the team
• Continually learning to stay current with industry standards, best practices and technology

As a Sea Mar employee, the individual in this position commits to adherence to these values to their utmost ability and endeavors to strengthen and embody this mission daily.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Leads CBO special projects and tracks and reports out to the Director of Revenue Cycle: baselines, timelines, key performance indicators (KPI’s), and operational and financial results
• Designs, monitors and improves CBO workflows
• Develops, implements, and monitors policies and procedures that ensure effective management of accounts receivable, while obtaining the highest level of reimbursement from payers and complying with all state and federal laws.
• Monitors charge capture activities including but not limited to electronic charges and paper encounter forms to ensure timely and accurate reimbursement for services billed in Medical, Dental and Behavioral Health. Actively monitors held claims ensuring only appropriate holds are in place and quickly resolved and released for timely claim submissions.
• Monitors billing and coding activities and patterns to ensure accurate billing and coding procedures are followed and are in compliance with state and federal laws
• Ensures failed and rejected claims and system edits are consistently caught up and identifies and resolves trends, training opportunities, and system set-up issues causing claims not to bill out
• Monitors and improves payment posting activities to ensure timely and accurate posting of payments, adjustments, and balance transfers based off electronic fund transfers (EFTs), electronic remittance advices (ERAs), paper payment batches and explanation of benefit (EOBs)
• Manages an effective denial management program ensuring claims are corrected accurately and timely before timely filing deadlines. Identifies and resolves trends, training opportunities, and system set-up issues causing denied claims
• Analyzes monthly appeals reports, tracking work effort to ensure effective collection activity on a regular basis; Reviews EOBs as needed to determine/address payer problems. Coordinates efforts regarding authorization issues
• Processes accurately and timely patient and insurance credit balances and sends check requests to management for approval
• Holds department accountable for the highest level of customer service when working with patients over the phone and assists in resolving patient concerns when complaints are made over the phone or on the website 
• Assists in developing and monitoring monthly CBO Key Performance Indicators (KPI’s) and ensures staff are meeting all productivity standards set for the department; Conducts regular audits of work performed by business office staff and provides regular feedback regarding work quality, performance, and productivity
• Coordinates and facilitates compliance audits for the department; Directs internal compliance reviews conducted by the department coders. Provides feedback and education to providers on coding errors for both procedure and E&M services in Medical, Dental and Behavioral Health.
• Serves as a key resource for changes in payment and coding guidelines from all payers. Educates and reeducates them on these continual updates. Responsible for constant and continual education of the providers on coding changes for Medical, Dental and Behavioral Health.  
• Verifies that fee schedules are appropriate against insurance payers' allowable fees.
• Becomes a Super User and trains all new-hire CBO staff on billing related practice management systems, electronic health records, clearing houses, web portals, and reporting tools
• Develops and maintains all billing related practice management system training curriculum, tip sheets, reference guides, and all other training and reference materials
• Facilitates and influences the credentialing process to assure prompt ability to bill for services rendered by newly hired providers in Medical, Dental and Behavioral Health 
• Has the authority to direct and support employees daily work activities.
• Creates and achieves monthly and annual department goals relating to revenue, reimbursement, productivity; Reports progress toward goals to management on a regular basis
• Reports operational and financial metrics of the Business Office to management monthly
• Assists the Revenue Cycle Manager and the Director of Revenue Cycle in driving process improvement initiatives related to front-end revenue cycle functions
• Assists the Revenue Cycle Manager in supervising all day-to-day operations and functions of the Central Business Office (CBO) including but not limited to posting charges, resolving failed claims and rejections, posting payments and adjustments, timely processing of secondary insurance, processing denials, bi-monthly rebills, following up with insurance companies on accounts not paid, customer service phone calls, resolving patient complaints, and collections of private past due accounts
• Becomes a subject matter expert in all matters relating to FQHC billing for Medical, Dental, and Behavioral Health and works collaboratively with other departments setting up effective billing processes for new clinics, service lines, and programs
• Perform other duties and special projects as assigned by Director of Revenue Cycle

CONDITIONS OF EMPLOYMENT

• This person must sign a confidentiality agreement covering all patient related information
• This person must receive a background check from the Washington State Patrol
• The new employee shall sign and date the job description to affirm the validity of the information herein, and to signify compliance with the conditions of employment

Qualifications

KNOWLEDGE

• This position requires a comprehensive understanding of accounts receivable management in a healthcare setting.  This position requires strong working knowledge of managed care plans, insurance carriers, referrals and precertification procedures.  Also required is a strong working knowledge of CPT, ICD-9, ICD-10, HCPCS, modifiers, coding and documentation guidelines.  Strong customer service, organizational and communication skills are essential to this position.  In addition, strict adherence to write-off policies, refund policies and other accounts receivable policies as outlined in the Procedure Manual is required.   This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment.  Also required are general computer skills, typing skills and a working knowledge of Medicare Compliance, OSHA and HIPAA.

EDUCATION AND TRAINING

• Bachelor’s degree in a healthcare or business or related field
• Minimum of three years of related work experience in healthcare billing, accounting, or finance;

Work experience beyond three years may be substituted for education on a year for year basis

• Minimum of three years supervisory experience in healthcare
• Current certified coder certificate from AAPC or AHIMA, preferred (not required)
• Proficient in personal computer applications, spreadsheet applications, and word processing
• Working knowledge of CPT and ICD-9/ICD-10 codes. Experience working with Medicare, Medicaid, Washington State DSHS, Labor & Industry, and commercial carriers.
• Experience working with HCFA and UB-92s. Ensure compliance with Federal and State regulations concerning medical billing.
• Work independently, exercise good judgment, and maintain confidentiality

LANGUAGE SKILLS

• English required; English/Spanish is a plus

MATHEMATICAL SKILLS

• Ability to add, subtract, multiply and divide in all units of measure using whole numbers, common fractions, and decimals.
• Ability to perform operational and statistical analysis.

REASONING ABILITY

• Must be able to compile, interpret, and utilize information.
• Must be able to resolve client billing problems in a timely manner.

Education, Certificates, Licenses, Registrations, and Medical Screening

• Bachelor’s degree in business or healthcare related field. Healthcare work experience beyond three years may be substituted for education on a year for year basis
• Current certified coder certificate from AAPC or AHIMA, preferred (not required)
• Washington State Divers License and automobile liability insurance coverage required for the use of personal vehicle in performance of duties when travel is indicated.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Revenue Cycle Supervisor position works the majority of time within an office setting. The position collaboratively communicates and works with other departments and Sea Mar employees. The position may interact with the community that Sea Mar serves through volunteering at community events. The position does require additional working hours outside traditional Sea Mar operating hours (Monday-Friday from 8am to 5pm) such as working weekends or evenings.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to sit at desk or computer for long periods. 
• Must be able to stoop, kneel, or crouch occasionally.

Hourly - Hourly Plan, 36.06 USD Hourly

What We Offer:

Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization. Working at Sea Mar Community Health Centers is more than just a job, it’s a fulfilling career with opportunity for advancement. The fringe benefits surpass most companies. For example, Full-time employees working 30 hours or more, receive an excellent benefit package of:

• Medical
• Dental
• Vision
• Prescription coverage
• Life Insurance
• Long Term Disability
• EAP (Employee Assistance Program)
• Paid-time-off starting at 24 days per year + 10 paid Holidays.
• We also offer 401(k)/Retirement options and an exciting opportunity to work in a culturally diverse environment. 

Sea Mar is an equal opportunity employer.

Please visit our website to learn more about us at www.seamar.org. You may also apply thru our Career page at this link.