SBO Reimbursement Coordinator

Time Type:
Full time
Hours per Pay Period:
80
Shift:
Day Shift 8-80
Minimum:
$63,225.00 USD
Maximum:
$85,539.00 USD(This represents the rate for an individual with significant experience in this job in a full-time 40 hour per week position)
Department:
Revenue Cycle
Current Bay Area Hospital Employee: If you are a current Bay Area Hospital employee, please apply through the Workday internal career site.
The future looks bright at Bay Area Hospital, and we are always searching for quality people to join our team. We offer a great atmosphere, competitive pay, a wide array of benefits, and many growth opportunities for our employees.
Job Description:
Coordinator SBO Reimbursement
This position is responsible for building and maintaining the EHR contract modules in Epic for the Single Billing Office (SBO) at Bay Area Hospital. The coordinator is responsible for system build, monitoring and working claim variances and collaborating with payers to resolve reimbursement related issues. This position also manages payer plan records and remit code mapping in collaboration with the other Community Connect partners.
EXPECTATION FOR ALL EMPLOYEES
Support the organization’s mission, vision and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all laws and regulations affecting Bay Area Hospital. Be familiar with and adhere to the Code of Conduct and support the Bay Area Hospital Compliance Program. Effective communication skills and the ability to work effectively with people from various backgrounds are critical.
POSITION SUMMARY
This position is responsible for building and maintaining the EHR contract modules in Epic for the Single Billing Office (SBO) at Bay Area Hospital. The coordinator is responsible for system build, monitoring and working claim variances, and collaborating with payers to resolve reimbursement related issues. This position also manages payer plan records and remit code mapping in collaboration with the other Community Connect partners.
PRINCIPLE DUTIES AND RESPONSIBILITIES
Accurately interprets contract reimbursement rates and methodology for build purposes
Builds and customizes payer plan specific contracts, including various reimbursement methodologies within Epic
Ensures adequate testing, quality assurance, and documentation of contract build in Epic
Responsible for tracking contract renewals and amendments
Performs continual maintenance and updating of existing contracts to reflect current reimbursement rates and methodologies; builds new contracts as needed
Performs ongoing testing and corrects build errors based on feedback from end users
Works collaboratively with payers and departments to resolve errors, issues and disputes
Conducts audits and completes testing of estimated contractual reimbursement
Responsible for facility, clearinghouse payer and remittance enrollments
Works bad debt file sent from IT on a monthly basis
Works low yield accounts from accounting on a monthly basis
Compiles daily, weekly and monthly statistical reports necessary for successful management of Revenue Cycle Operations and AR Management
Evaluates material variances and trends to identify and resolve root causes
Trends professional fee variances and works directly with health plans to resolve issues
Prepares analysis related to the financial performance of existing payer contracts in order to identify opportunities for improvement and recommend areas for improvement
Supports payer contracting proposed negotiations by modeling payor contracts to identify effective rate proposals
Works collaboratively with other revenue cycle and hospital departments, external agencies, vendors, payers and Community Connect partners, communicating effectively in both written and verbal formats with staff, peers, all levels of management, and all encounters both inside and outside the organization
Provides oversight, prioritizes workflow and monitors performance to support key performance indicators
Collaborates with Patient Access, HIM, Revenue Integrity and Contract Management to support revenue cycle functions and identify opportunities for improvement; implements performance improvement plans
Promotes and supports the achievement of organizational goals and revenue cycle objectives
Provides and promotes professional, efficient and congenial customer service through all communication and interaction with customers
Ensures department compliance with hospital policies, all applicable federal and state laws, regulatory requirements and payer guidelines
Audits and manages all collection and write-off activities, ensuring adherence to guidelines and policies
Oversees third party vendor performance to meet performance expectations for assigned work
Plans for and oversees the implementation of new software as well as maintenance, ensuring existing software processes meet the needs of the organization
Serves as a contact point for reimbursement questions from clinical and non-clinical departments
Collaborates with Community Connect team to maintain Payer/Plan tables in Epic
Maintains knowledge of department and organizational structure, workflow and operating procedures
Attends training and completes online training as assigned
Participates in and completes department and organizational projects
Understands procedures for all emergency situations and responds appropriately
Other duties as assigned
SKILLS AND ABILITIES
Able to understand and interpret payer contracts; research, collect and analyze contract information as required
Ability to accurately build contracts into the contract management system and Epic contract applications
Must be able to calculate and audit expected reimbursement in order to determine accuracy of payment
Possess specific knowledge of Third-Party Healthcare Arrangements and ability to apply that knowledge
Working knowledge of remittance codes, including CARC and RARC codes that can impact adjustments and denials
Knowledge of 837i and 837p electronic claim formats
Demonstrates working knowledge in applicable systems, including but not limited to Epic, Experian, OnBase, Excel, Word and Teams
Demonstrates dynamic leadership skills to promote and support the achievement of overall organizational goals and specific revenue cycle objectives
Familiarity with industry best practices and standards
Ability to translate complex problems and concepts
Effective and professional communication skills, both verbal and written
Good interpersonal skills and ability to communicate with all levels of management
Excellent team building and management skills
Organizational skills that promote the ability to work well without direct supervision, manage time effectively, and appropriately prioritize multiple assignments to meet project deadlines
Effective collaboration and communication with a variety of individuals, both internal and external, including multidisciplinary teams
Ensures recommendations support adherence to all federal, state and other regulatory requirements
Communicates effectively with all constituents and keeps leadership informed of issues
Demonstrates ability to problem solve, work independently and as part of a team
Demonstrates initiative and exercises good judgment and effective critical thinking skills
Flexible; able to prioritize and address multiple responsibilities concurrently and meet deadlines
Works effectively under stress and in frequently changing job requirements/situations
Exhibits the ability to deal effectively interdepartmentally and with the public
Exhibits the ability to maintain confidentiality, think and act independently with minimal supervision
Flexibility in job schedule to provide user support and advance project goals
Maintains regular, consistent and punctual attendance at the assigned job location
EDUCATION/CERTIFICATIONS/LICENSES/DEGREES
High school graduate or equivalent
Associate’s or Bachelor’s degree preferred