Manager Collections

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This function is responsible for Managing Billing, collections and/or payment posting team(s) for optimum reduction of AR Days aging and/or FBNS, and working with payers to improve or maintain cash goals set. Positions in this function interact with customers (internal and external) gathering support data to ensure accurate billing and collection processes are followed. Provide input to policies, systems, methods, and procedures for the effective management and control of the premium collection. Educate customers regarding issues or concerns in achieving the goals set. Monitor outstanding balances and take appropriate actions to ensure responsible parties (payers, IPA or other) pay as billed. Manage the preparation reporting to upper leadership and complete reconciliation of billing or collection with leadership, teams and or client. 

This position is responsible for managing and coordinating team efforts toward a specific service delivery function of the facility.  The position provides coaching, feedback, and corrective action to service delivery team members where needed.

The Manager carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of organization and carries out the Vision and Mission of the organization

Primary Responsibilities:

• During transition of any project, the manager should assist in planning, preparing and integrating facility Billing processes
• Manage the work of team members by empowering, coaching, answering questions, giving guidance, and leading by example. The manager is expected to conduct skip conversations, focus group discussions, triad sessions and coaching audits as frequency determined by superior
• Ensure that adequate procedures exist for accurate and timely processing of claims to payers
• Ensure compliance with state and federal laws regulations for Medicaid, Medicare, non-government and other third-party billings
• The billing manager should, monitor on-line claim editing, submission and reconciliation procedures; ensure compliance with CPT, HCPCS and ICD coding regulations and guidelines
• Provide relevant guidance to Supervisors and staff to resolve internal and external issues
• Inform leadership of any significant issues in the Billing/ collections area (e.g., Billing backlogs, HIM bill drop delays, payer issues, vendor issues, etc.)
• Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education
• Help ensure that appropriate personnel policies are adhered to, and any personnel problems are addressed in an appropriate and timely manner
• Assist in hiring, managing and developing department staff to ensure appropriate skills base is present in the staff, as well as to ensure that skills needed for future needs are developed in advance of their need
• Assist in establishing and monitoring controls to ensure appropriate submission and acceptance of electronic and manual bills
• Monitor and report issues that will affect cash performance (rejections, denials, timely filing) and act on trends and/or root causes
• Monitor performance according to quality and productivity standards developed internally and documented in SLAs
• Review adjustment requests and approve those which are valid for write-off
• Help coordinate and promote implementation and monitoring of standard processes, reporting and education programs
• Assist in the implementation of company-wide initiatives such as the development of operational models, education programs and contract compliance
• Develop specific objectives and performance standards for each area of responsibility
• Identify and implement process improvements to lower costs and improve service to facility customers
• Identify opportunities for innovation, knowledge sharing and other leading practices within facility managed and among peer group
• Perform staff reviews and prepare performance documents for direct reports
• Conduct team/ client performance reviews and ensures action plans in place to meet SLA/MBO requirements
• Collaborate with onshore partners on inventory management, payer trend issues and other items impacting SLA requirements
• Evaluates quality processes and seeks opportunities to streamline
• Considers the customer experience, business impact and solution objective when managing risks and development and design of solutions
• Projects possible attrition and creates and implements actions to drive employee retention
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
• When necessary, escalates accounts to appropriate facility and or department leadership staff
• Develops key documentation and power points, including but not limited to: Risk/Issue/Action Plans, Meeting Minutes, etc.to establish and maintain regular follow up with identified stakeholders tracking progress and identifying risks
• Promotes team work and displays ability to effectively communicate and coordinate multiple activities both domestic and global
• Assists leadership in project management activities, including but not limited to:
  • Scope Management – Plans and controls scope for simple to complex projects
  • Data Management – Effectively collects, catalogs, maintains and utilizes account data to analyze current state work effort and situation(s), proposed future state operations and actual outcomes to drive improvement
  • Work plan Management – Effectively creates, maintains and communicates identified issues related to work effort, resources and statuses to meet financial team goals
  • Risk/Issue/Action Item Management – Effectively facilitates the defined approach through  communication in partnership with their Supervisor/  Anticipates complex issues and facilitates resolution, escalates issues with the proper balance of urgency and calm/composure
• Other duties as needed and assigned by their superior
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Bachelor’s degree in business or related field
• Work Experience:
  • 5+ years of experience in Hospital Revenue Cycle or must undergo process training and pass ramp certification
  • 2+ years of management/leadership experience
  • Thorough understanding of insurance policies and procedures
  • Working knowledge of medical terminology
  • Intermediate to advanced computer skills, must understand Excel
  • Proven excellent written and verbal communication
• Technical Knowledge
  • Excellent analytical and quantitative skills; ability to develop appropriate methods for collecting analyzing and trending data
  • Excellent organizational skills required (ability to multi-task, produce rapid turnaround, and effectively manage multiple projects)
  • High sense of responsibility and accountability; Takes ownership and initiative
  • Results-oriented with an eye toward the end-goal and business results as the objective of our projects
  • Ability to think and act; decisiveness, assertiveness, with ability to achieve results quickly
  • Excellent communication capability; persuasive, inclusive, and encouraging; the ability to listen and understand; Ability to elicit cooperation from a variety of resources
  • Adaptable and flexible, with the ability to handle ambiguity and sometimes changing priorities
  • Professional demeanor and positive attitude; customer service orientation
  • Ability to learn, understand, and apply new technologies, methods, and processes
  • Ability to recognize necessary changes in priority of tasks and allocation of resources, and bring them to the attention of Optum360 Leadership, as required
  • Ability to be a self-starter and work independently to move projects successfully forward
  • Ability to work with a variety of individuals in managerial and staff level positions
  • Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Optum and our client organization(s)