SBO Reimbursement Coordinator

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Hours per Pay Period:

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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:

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

• Current Epic certifications or ability to gain certification within 180 days (6 months) required:

• • Resolute Hospital Billing Expected Reimbursement Contracts Administration

• • Resolute Professional Billing Reimbursement Contracts

• Healthcare certification (AAHAM, NAHAM, HFMA), Epic Certification and/or training preferred

EXPERIENCE

• Minimum of five years of work experience in healthcare revenue cycle, with a minimum of two years working with hospital payer contracts, reimbursement methodologies, coding, billing and claims

• Experience with Epic, Experian, Craneware, Optum, 3M or other revenue cycle solutions software required

• Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook and Excel), WebEx, Teams or other remote meeting/communication platforms

• Project management, technical implementations, and change management experience a plus

GENERAL INFORMATION

Union Affiliation: None

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position.  They are not intended to be an exhaustive list of all duties, responsibilities and job skills required.

Physical/Mental/Environmental Requirements

• Requires extensive sitting with periodic standing and walking

• May be required to lift up to 20 pounds

• Requires significant use of personal computer, phone and general office equipment

• Needs adequate visual acuity, ability to grasp and handle objects

• Needs ability to communicate effectively through reading, writing, and speaking in person or by telephone

• May require off-site travel

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

• Current Epic certifications or ability to gain certification within 180 days (6 months) required:

• • Resolute Hospital Billing Expected Reimbursement Contracts Administration

• • Resolute Professional Billing Reimbursement Contracts

• Healthcare certification (AAHAM, NAHAM, HFMA), Epic Certification and/or training preferred

EXPERIENCE

• Minimum of five years of work experience in healthcare revenue cycle, with a minimum of two years working with hospital payer contracts, reimbursement methodologies, coding, billing and claims

• Experience with Epic, Experian, Craneware, Optum, 3M or other revenue cycle solutions software required

• Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook and Excel), WebEx, Teams or other remote meeting/communication platforms

• Project management, technical implementations, and change management experience a plus

GENERAL INFORMATION

Union Affiliation: None

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position.  They are not intended to be an exhaustive list of all duties, responsibilities and job skills required.

Physical/Mental/Environmental Requirements

• Requires extensive sitting with periodic standing and walking

• May be required to lift up to 20 pounds

• Requires significant use of personal computer, phone and general office equipment

• Needs adequate visual acuity, ability to grasp and handle objects

• Needs ability to communicate effectively through reading, writing, and speaking in person or by telephone

• May require off-site travel

Compensation Grade:

Compensation Grade Profile:

Bay Area Hospital is an Equal Opportunity Employer.

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