Manager, Insurance AR

Role Summary

The Manager, Insurance AR is an exciting new role that will help practices on the OneOncology platform better manage and monitor their accounts receivable (AR) and Billing issues. This position will provide OneOncology practices with oversight of their Accounts Receivable and Billing Processes.

Responsibilities

• Lead Billing/AR operations for OneOncology shared services overseeing multiple practices.
• Drive practice Billing/AR KPI’s to reach established targets.
• Develop strategy for denial prevention by using system functionality/billing edits.
• Develop long-term relationships and lead through influence with key resources at payers to help drive down Practice AR.
• Identify and troubleshoot billing and payer issues by analyzing denials, aging AR, and payer feedback.
• Understand national payer guidelines, large local payer guidelines, coding requirements, and billing-related regulatory requirements to guide RCM teams on best practices for collections and billing workflows.
• Identify root cause and trends leading AR to age and identify how to proactively address.
• Become familiar with payer policies regarding corrected claims, payer portals, appeal levels and timely and appeal limits.
• Maximize AR tool in order to identify high priority claims and monitor performance of RCM team.
• Create best practices for resolving patient AR including creating workflows that can be done pre and post visit to address AR build up quicker.
• Maintain relationships with key stakeholders at our partner practices to better understand billing processes and system capabilities.
• Must work collaboratively with other members of RCM leadership team.
• Interface with physicians as needed regarding any billing RCM issues.

Required or Preferred Qualifications

• Bachelor’s degree or equivalent healthcare related experience required.
• 7+ years of experience in community oncology/surgical/urology industry and/or similar field leading AR resolution and Billing processes.
• Working knowledge of Billing, Collections, Government Payers, Managed Care Payers, Private, and Third Party Insurances required.
• Thorough knowledge of ICD10, CPT, HCPCS, and coding guidelines for all lines of business, including but not limited to urology and surgery. Coding certification preferred.
• Ability to multi-task and oversee multiple projects at once.
• Knowledge of OncoEMR, Modernizing Medicine (EMMA), Candid, and Intergy a plus.

Essential Competencies

• Deep understanding of physician practice operations.
• Experience utilizing claim, scrubbing software, writing and maintaining billing/claim rules that produce clean claims, including knowledge of payer specific guidelines.
• Ability to communicate to practice leadership regarding clinical or operational workflows that could be leading to Billing/AR issues for certain specialties, payers, etc.
• Strong ability to communicate across all levels of a payer to support AR resolution – including getting in the details of individual claims as well as escalating to more senior resources at the payer.
• Solid analytical skills with ability to deep dive into groups of accounts or claims to determine root cause.
• Good skills with Excel with the ability to slice and data from the EMR and Practice Management system to gain better insights into Billing/AR issues.
• Experience with Billing/AR escalations including writing 1st and 2nd level appeals and managing payer escalations with payers.
• Ability to grasp clinical concepts that may be leading to AR build up – i.e. Medical Record requests and rationale by the payer.