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Stony Brook University
Assistant Director for Pre-Bill and Utilization Management
Required Qualifications (as evidenced by an attached resume):
Bachelor's degree (foreign equivalent or higher). Four (4) years of full-time experience in healthcare revenue cycle or healthcare billing. Experience working with Medical Electronic Health Records. Familiarity with procedure codes and diagnostic codes. Proficiency with Microsoft Office Suite.
Bachelor's degree (foreign equivalent or higher) in Health Information Management, Health Administration, Finance, Accounting, Computer Science or related field. Certified Coder. Two (2) years of full-time supervisory experience. Expertise in dental billing requirements including the use of ADA Form, Medicare, and New York Medicaid reimbursement methodologies. Knowledge of third-party payer reimbursement and managed care contracts. Experience investigating rejected/denied dental claims. Knowledge of CDT and ICD-10 coding principles. Experience with axiUm Electronic Health Record. Experience with insurance verification and updating. Customer service experience.
Brief Description of Duties:
Under the direction of the Director of Revenue Cycle Management, this position is responsible for reviewing and overseeing pre-billing activities including the pre-claim review process, resolving claim denials, determining fee reductions, and utilization management. This position maintains a validated process to ensure patient records contain clinical documentation to support treatment. The position ensures that all clinical documentation for dates of service are reviewed, submitted, and adjusted timely to meet healthcare billing regulatory requirements, increase the clinic's collection rate and reduce AR.
The successful candidate is able to work with little to no supervision, work independently, and serve as a team player in collaborating on projects. The successful incumbent will possess excellent written and verbal communication skills. The Assistant Director for Pre-Bill & Utilization Management will have the ability to communicate with commercial and governmental payers. Strong follow-up and customer service skills is key in this role. The incumbent must be able to communicate with all levels of management. This position reports to the Director of Revenue Cycle.
Pre-bill and Utilization Management:
• Responsible for pre-bill/claim reviews and utilization management not limited to insurance eligibility and verification, preauthorization, pre-claim review of procedure codes and assigned notes, and appeals.
• Monitor date of service records prior to bill/claim submission for each patient to verify that procedure codes and treatment notes support the claim, and accurately reflect the actual service rendered to the patient.
• Review unsubmitted procedures in accordance with DCC Pre-claim Review Policy.
• Assist with billing NYS Medicaid, Medicaid Managed Care, Commercial, and Self-Pay patients.
• Collaborate with the Revenue Cycle Management Unit team to ensure billing statements, insurance claims, and treatment reports are simple, clear, direct, and accurate representation of services provided, the fees charged for each service, and the nature of the patient's treatment.
• Determine and report on billing trends, in order to address billing issues timely.
• Communicate about patient accounts with all levels of management.
• Escalate outstanding issues to Revenue Cycle Leadership for resolution.
• Liaise with third-party collection agencies.
• In accordance with segregation of duties protocols, prepare, review, and submit dental bills/claims including adjustment, write-offs, void, denials, coding issue, and audits.
Bill Denial & Fee Reduction Management:
• Resolve claim denials and submit appeals for reimbursement.
• Become an expert on developing information on common claim denials and how to respond to these denials, and how to develop protocols for preventing and resolving common errors.
• Follow-up on rejected or denied claims, improper payments and coding issues, and process appeals.
• Identify issues and patterns with claims/insurance providers, and review to increase revenue and prevent unnecessary denials.
• Investigate and accurately update Coordination of Benefits (COB) and Explanation of Benefits (EOB), including refund requests, write-off forms, adjustment reports, and etc.
• Write-off claim denials that are deemed non-payable after appealing with the Payer.
• Assist the Director to update managed care and commercial insurance contracts.
• Coordinate and track fee reduction requests and input adjustments/write-offs, as needed.
Supervisory & Training:
• Supervise the training of employees in a pre-bill clinical documentation integrity review process.
• Assist the Director in the RCMU staff on new/specialized control agency policies and procedures changes and make recommendations to improve internal protocols as needed.
• Other duties or projects as assigned as appropriate to rank and departmental mission.
This is a full-time appointment. FLSA Exempt position, not eligible for the overtime provisions of the FLSA. Minimum salary threshold must be met to maintain FLSA exemption.
Essential Position: This has been designated as an essential position based on the duties of the job and the functions performed. Positions that are designated as such may be required to report to work/remain at work even if classes are cancelled, and the campus is working on limited operations in an emergency.
In accordance with the New York State Department of Health (DOH) order that all hospitals and nursing homes “continuously require all personnel to be fully vaccinated against COVID-19,” Candidates who are not already vaccinated must obtain the first dose of the vaccine within three (3) calendar days of acceptance of conditional job offer and must obtain any subsequent doses in accordance with the vaccine protocol. The order also includes those who may be affiliated with or interact with employees of a hospital or nursing home. The order allows for limited medical exemptions with reasonable accommodations, consistent with applicable law.
Resume/CV and cover letter should be included with the online application.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at or visit https://www.stonybrook.edu/commcms/oea/.
In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewedhttps://www.stonybrook.edu/police/.
Visit ourhttps://www.stonybrook.edu/commcms/jobs/working-here/index.php page to learn about the total rewards we offer.
Job Number: 2103282Official Job Title: Senior Staff AssistantJob Field: Administrative & Professional (non-Clinical)Primary Location: US-NY-Stony BrookDepartment/Hiring Area: Dental Care CenterSchedule: Full-time Shift :Day Shift Shift Hours: 8:30 a.m. - 5:00 p.m. Posting Start Date: Sep 17, 2021Posting End Date: Dec 31, 2021, 8:59:00 PMSalary:Commensurate with experience within the range of $60,000 - $65,000.Appointment Type: Term
To apply, visit https://apptrkr.com/2544565
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