: Connecticut-Farmington-9 Farm Springs Rd Farmington (10566)
: Coding and Billing
: Hartford HealthCare Corp.
: Dec 27, 2024
Mgr Quality Assurance Rev Cycl / Rev Cycle Prof Svcs Adm - (24166597)
Work where every moment matters.
Every day, over 38,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.
The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.
With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.
Position Summary:
The Manager for Quality Assurance oversees the team that handles accurate collection of third party revenue cycle activities associated with outstanding insurance claims across all of Hartford HealthCare hospitals, medical group and homecare to insure optimal revenue cycle performance. The team handles the submission, edit resolution, and denial correction for all third part payers. This role oversees the day to day operational activities related to account receivables/claims for both Hospital (claims) & Professional Billing (A/R and claims). The manager provides oversight and leadership to the staff and works with other departmental leaders to ensure accuracy of information billed. The manager is responsible for responding to organizational inquires as well as a pro-active partnership with leadership regarding denial reduction strategies.
The manager is responsible for $650 million in active inventory and provides leadership to the team lead and staff including management of human resources, vendors, and client relations. The position reports directly to the Director of Revenue Cycle and works closely with other managers/directors throughout the organization. The manager is responsible for keeping abreast of all state/federal regulations and assists the organization in complying with these guidelines. He/she is also responsible to ensure that a high quality, cost-effective product or service is delivered in support of the Hartford HealthCare core values, strategic plan and established Revenue Cycle goals and objectives.
Position Responsibilities:
Key Areas of Responsibility
1. Plan, develop, organize, implement, evaluate and direct the accounts receivable functions associated with timely collection of insurance receivables under the supervision of the Director.
2. Analyze and observe AR functions and processes to ensure maximum workflow and productivity, communicating deficiencies as well as best practices to operation management. Responsible for documenting and implementing policies and procedures.
3. Provide and conduct subject matter training as needed with AR Follow Up staff and other departments as needed. Monitor, update and train to financial policies and procedures related to current Company policy and industry specific government regulations in effect.
4. Responsible for the timely realization of payment for approximately $550 million in active inventory and $70 million in denials, overseeing the effective appeals of these claims and protecting against bad debt in this endeavor. These numbers will increase with new acquisitions.
5. Works closely with other teams within and outside of Revenue Cycle to support efforts to ensure reimbursement is in line with payer contract agreements and policies.
6. Participates in the Management of vendor relationships and monitor performance.
7. Approve allowance and write off requests to $99,999.99
8. Providing support for other ad hoc analyses and projects as needed
9. Demonstrates H3W Leadership Behaviors.
10. May contribute to the outcomes of the defined function by performing the work of the function as required (very minimal).
11. Develops, implements and monitors meaningful goals and objectives for the department that align with the strategic direction of the organization and industry best practice metrics. Models the effective efficient operation of the unit by, providing clear and specific goals and timely feedback.
12. Track trends and evaluates results. Continually strives to improve quality and productivity by identifying improvement opportunities and recommending and implementing changes where there are opportunities for improvement.
13. Effectively and continually communicates with staff, management and customers to facilitate the flow of information. Continually strives to improve quality and productivity by identifying improvement opportunities and recommending and implementing changes where there are opportunities for improvement
14. Actively seeks opportunities to model teamwork through collaboration both within and outside the workgroup in support of the organizations objectives.
15. Implements individual performance expectations and coaches, develops and evaluates performance to enable employees to be successful in contributing to the achievement of individual and workgroup objectives.
16. Manages general HR related issues, this includes annual performance reviews, implementing HR policies, approving PTO and hiring staff. Works with employees on professional development and training opportunities. Manages teams time and attendance; including scheduling, review and approval of time off requests, entering and adjusting timekeeping in Kronos, and tracking of attendance in accordance with policy.
17. Development of a training and onboarding plan for new staff members joining the department.
18. Assumes responsibility for self-improvement in collaboration with superior.
19. Maintain effective positive customer service, insuring the needs are met and educating staff on the importance of quality customer service.
Working Relationships:
o Direct supervision of Accounts Receivable Supervisors and their efforts to successfully procure payments for the HHC organization across all hospitals. Averages 65+ FTEs with 6+ supervisors as direct reports. Responsible for time and attendance tracking, management, and approval bi-monthly. Responsible for annual performance reviews and develops and implements performance improvement plans where appropriate. Interviews and makes hiring decisions.
o Manages AR engagements with small balance vendor, credit balance vendor, worker’s compensation vendor and out of state Medicaid vendor.
Requirements and Specifications:
Education
Experience
Licensure, Certification, Registration
Knowledge, Skills and Ability Requirements
We take great care of careers.
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.
Regular
Standard Hours Per Week: 40
Schedule: Full-time (40 hours)
Shift Details: This position is an on site position located in Farmington, CT.
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