East Carolina University
Manager of Accounts Receivable and Coding
East Carolina University, Greenville, North Carolina, United States, 27834
Overview
This position is within the Office of Business Operations and Financial Affairs (B&F) at the ECU School of Dental Medicine (SoDM). It reports to the Director of Revenue Cycle and serves as the Manager, Accounts Receivable and Coding. The role is responsible for core accounts receivable (AR) functions including account resolution and collection of claims (approximately $16 million annually), workflows for B&F staff to optimize collections, and determination of appeals of denied claims. It also manages the division of responsibilities between B&F and CSLC staff related to account collection and resolution.
The position oversees all aspects of coding and its integration with account collection, in collaboration with the Manager, Cash Management and Claims, the interface of coding related to pre-submitted claims, and the overall communication and education/training of coding with Faculty and Students, including annual changes in codes and/or their interpretation.
The Manager of Accounts Receivable and Coding is responsible for the composition and administration of the SoDM’s prospective audit, communications with Faculty to discuss claims requiring changes, and education of both Faculty and students on aspects of coding their services and specific coding interpretations. The role also interfaces with and aligns with the Office of Institutional Integrity (OII) on external coding audits or inquiries.
Clinical and Operational Context The clinical enterprise includes six clinical operations within Ross Hall (Student Clinic, Student Learning Center (SLC), Pediatric/Orthodontic Clinic, Faculty Practice Clinic (FP), Advanced Education in General Dentistry (AEGD) and the Clinical Research Center); the General Practice Residency Clinic (GPR); and eight Community Service-Learning Centers (CSLCs) located across North Carolina.
Core Process Management 60%
Description of job responsibility/duty:
The Manager, Accounts Receivable and Coding manages the business functions of outstanding receivable accounts for both insurance and patients, interpreting insurance company billing policies, implementing internal policies to determine which claims are considered resolved, under what auspices denied claims will be considered unresolved and appealed, and which amounts unpaid by insurance will be transferred to patients. This role translates broad policies and procedures from State and Federal Governments and University Departments to develop and maintain sustainable operating procedures. It is responsible for primary reporting and compliance components of these elements of SoDM’s Revenue Cycle, including metrics such as days in AR, AR aging, percentages of denials, net collections, and overall collections. The position analyzes financial data to identify patterns that help recover missed payments and improve revenue; it requires current knowledge of billing regulations, clinical coverage policies and insurance industry changes, acting as the organization’s subject matter expert on coding. It is also responsible for the coding operations and monitors all processes, procedures and activities related to the prospective audit, working under the supervision of the Director. It determines, with the Director, the composition of the audit (codes, clinics/providers, and percentage of a provider’s or code’s claims included) to optimize compliance with documentation, dental record accuracy and appropriate reimbursement. The position supervises two FT Advanced Accounting Technicians – Remittance, one University Program Associate, and 1.75 FTE Coders.
Business Administration 20%
Description of job responsibility/duty:
The position provides leadership, administrative direction and training in developing processes, policies and systems that contribute to successful business operations. It applies continuous improvement practices in both dental/clinical operations and financial operations to optimize performance in a changing regulatory environment. It promotes employee engagement and optimal performance in a cooperative, goal-oriented culture. It develops policies and procedures to ensure appropriate internal controls of clinical billing reconciliation and correct designation of expenditures to meet generally accepted accounting principles. The role requires in-depth knowledge of current dental and medical insurance payor guidelines and regulations, and an ability to optimize processes for account collection and reconciliation, ongoing high-volume coding audits, and training for B&F staff to prevent denials and for faculty and students to improve coding accuracy. The role collaborates with faculty, students, other Managers and staff in a professional and collaborative manner. Working with the Director and Manager of Cash Management and Claims in Business and Finance, the position applies monitoring tools and meets established performance metrics (e.g., timely appeals of claims, timely responses to B&F staff inquiries, coordination of post-submission revenue cycle processes with pre-submission processes). It supports the Director and works with the Manager of Cash Management and Claims to meet departmental and organizational standards such as Days in AR, AR aging, percentage of denials, net collections and overall collections. The role requires a super-user level of expertise with the axiUm system (School’s Dental Management Software System) and competence in university systems such as Business Intelligence, to link technology to process to people effectively.
Departmental/Vendor Liaison 10%
Description of job responsibility/duty:
Departmental/Vendor Liaison: Work effectively in a team environment with B&F management, Clinical Affairs and CSLC management and staff, other internal University Departments (e.g., Office of Institutional Integrity (OII), Internal Audit) and external stakeholders such as insurance companies (e.g., Delta Dental, United Healthcare) and private/public entities. This position independently resolves and collaborates to resolve complex issues, serves as a trainer and resource to SoDM, and provides support and training for all post-claims submission revenue cycle issues for all SoDM clinics at Ross Hall as well as remote operations including CSLCs and GPR. The role focuses on best practices and standardization of processes across all SoDM clinics and continuous improvement, overseeing all customer service elements of the revenue cycle to ensure staff provide accurate, professional, and customer-centric service to internal stakeholders or patients with questions or issues about SoDM accounts.
Research and Analysis 10%
Description of job responsibility/duty:
In support of the Director and B&F, conduct analyses, document findings, prepare presentations, provide recommendations and execute agreed-upon plans. Maintain current knowledge of payor and regulatory issues and apply operational changes as needed to optimize functions in this changing environment. This position anticipates problems and develops recommendations for management resolution.
Contingent upon available funding.
Employment in this position provides eligibility to participate in the UNC Optional Retirement Program (ORP) with employer matching contributions and retirement plan options, as well as eligibility for Voluntary Supplemental Retirement Plans (401k, 403b, 457). This position is not eligible for the NC Teachers’ and State Employees’ Retirement System (TSERS). Additionally, the position offers multiple voluntary options for Medical, Dental, Vision, and Life Insurance and various supplemental plans including Critical Illness, Flexible Spending Accounts, Cancer, and Disability.
#J-18808-Ljbffr
The position oversees all aspects of coding and its integration with account collection, in collaboration with the Manager, Cash Management and Claims, the interface of coding related to pre-submitted claims, and the overall communication and education/training of coding with Faculty and Students, including annual changes in codes and/or their interpretation.
The Manager of Accounts Receivable and Coding is responsible for the composition and administration of the SoDM’s prospective audit, communications with Faculty to discuss claims requiring changes, and education of both Faculty and students on aspects of coding their services and specific coding interpretations. The role also interfaces with and aligns with the Office of Institutional Integrity (OII) on external coding audits or inquiries.
Clinical and Operational Context The clinical enterprise includes six clinical operations within Ross Hall (Student Clinic, Student Learning Center (SLC), Pediatric/Orthodontic Clinic, Faculty Practice Clinic (FP), Advanced Education in General Dentistry (AEGD) and the Clinical Research Center); the General Practice Residency Clinic (GPR); and eight Community Service-Learning Centers (CSLCs) located across North Carolina.
Core Process Management 60%
Description of job responsibility/duty:
The Manager, Accounts Receivable and Coding manages the business functions of outstanding receivable accounts for both insurance and patients, interpreting insurance company billing policies, implementing internal policies to determine which claims are considered resolved, under what auspices denied claims will be considered unresolved and appealed, and which amounts unpaid by insurance will be transferred to patients. This role translates broad policies and procedures from State and Federal Governments and University Departments to develop and maintain sustainable operating procedures. It is responsible for primary reporting and compliance components of these elements of SoDM’s Revenue Cycle, including metrics such as days in AR, AR aging, percentages of denials, net collections, and overall collections. The position analyzes financial data to identify patterns that help recover missed payments and improve revenue; it requires current knowledge of billing regulations, clinical coverage policies and insurance industry changes, acting as the organization’s subject matter expert on coding. It is also responsible for the coding operations and monitors all processes, procedures and activities related to the prospective audit, working under the supervision of the Director. It determines, with the Director, the composition of the audit (codes, clinics/providers, and percentage of a provider’s or code’s claims included) to optimize compliance with documentation, dental record accuracy and appropriate reimbursement. The position supervises two FT Advanced Accounting Technicians – Remittance, one University Program Associate, and 1.75 FTE Coders.
Business Administration 20%
Description of job responsibility/duty:
The position provides leadership, administrative direction and training in developing processes, policies and systems that contribute to successful business operations. It applies continuous improvement practices in both dental/clinical operations and financial operations to optimize performance in a changing regulatory environment. It promotes employee engagement and optimal performance in a cooperative, goal-oriented culture. It develops policies and procedures to ensure appropriate internal controls of clinical billing reconciliation and correct designation of expenditures to meet generally accepted accounting principles. The role requires in-depth knowledge of current dental and medical insurance payor guidelines and regulations, and an ability to optimize processes for account collection and reconciliation, ongoing high-volume coding audits, and training for B&F staff to prevent denials and for faculty and students to improve coding accuracy. The role collaborates with faculty, students, other Managers and staff in a professional and collaborative manner. Working with the Director and Manager of Cash Management and Claims in Business and Finance, the position applies monitoring tools and meets established performance metrics (e.g., timely appeals of claims, timely responses to B&F staff inquiries, coordination of post-submission revenue cycle processes with pre-submission processes). It supports the Director and works with the Manager of Cash Management and Claims to meet departmental and organizational standards such as Days in AR, AR aging, percentage of denials, net collections and overall collections. The role requires a super-user level of expertise with the axiUm system (School’s Dental Management Software System) and competence in university systems such as Business Intelligence, to link technology to process to people effectively.
Departmental/Vendor Liaison 10%
Description of job responsibility/duty:
Departmental/Vendor Liaison: Work effectively in a team environment with B&F management, Clinical Affairs and CSLC management and staff, other internal University Departments (e.g., Office of Institutional Integrity (OII), Internal Audit) and external stakeholders such as insurance companies (e.g., Delta Dental, United Healthcare) and private/public entities. This position independently resolves and collaborates to resolve complex issues, serves as a trainer and resource to SoDM, and provides support and training for all post-claims submission revenue cycle issues for all SoDM clinics at Ross Hall as well as remote operations including CSLCs and GPR. The role focuses on best practices and standardization of processes across all SoDM clinics and continuous improvement, overseeing all customer service elements of the revenue cycle to ensure staff provide accurate, professional, and customer-centric service to internal stakeholders or patients with questions or issues about SoDM accounts.
Research and Analysis 10%
Description of job responsibility/duty:
In support of the Director and B&F, conduct analyses, document findings, prepare presentations, provide recommendations and execute agreed-upon plans. Maintain current knowledge of payor and regulatory issues and apply operational changes as needed to optimize functions in this changing environment. This position anticipates problems and develops recommendations for management resolution.
Contingent upon available funding.
Employment in this position provides eligibility to participate in the UNC Optional Retirement Program (ORP) with employer matching contributions and retirement plan options, as well as eligibility for Voluntary Supplemental Retirement Plans (401k, 403b, 457). This position is not eligible for the NC Teachers’ and State Employees’ Retirement System (TSERS). Additionally, the position offers multiple voluntary options for Medical, Dental, Vision, and Life Insurance and various supplemental plans including Critical Illness, Flexible Spending Accounts, Cancer, and Disability.
#J-18808-Ljbffr