Feb 02, 2025

Senior Manager Billing - Surgical Management Solutions

Accounting Management

Job Description

Senior Manager Billing - Surgical Management Solutions

JOB_DESCRIPTION.SHARE.HTML

CAROUSEL_PARAGRAPH

JOB_DESCRIPTION.SHARE.HTML
  • United States
  • Surgical Management Solutions LLC
  • Billing
  • Regular
  • Full-time
  • 1
  • USD $73,898.00/Yr.
  • USD $85,000.00/Yr.
  • 38735
SCA Health

Job Description

Overview

Today, SCA Health has grown to 11,000 teammates who care for 1 million patients each year and support physician specialists holistically in many aspects of patient care. Together, our teammates create value in specialty care by aligning physicians, health plans and health systems around a common goal: delivering on the quadruple aim of high-quality outcomes and a better experience for patients and providers, all at a lower total cost of care.

As part of Optum, we participate in an integrated care delivery system that enables us to support our partners as they navigate a complex healthcare environment, Only SCA Health has a dynamic group of physician-driven, specialty care businesses that allows us to customize solutions, no matter the need or challenge:

  • We connect patients to physicians in new and differentiated ways as part of Optum and with our new Specialty Management Solutions business.
  • We have pioneered a physician-led, multi-site model of practice solutions that restores physician agency by aligning incentives to support growth and transition to value-based care.
  • We lead the industry in value-based payment solutions through our Global 1 bundled payment convener, that provides easy predictable billing to patients.
  • We help physicians address everything beyond surgical procedures, including anesthesia and ancillary service lines.

The new SCA Health represents who we are today and where we are going—and the growing career opportunities for YOU.


Responsibilities

The Senior Manager Billing will oversee the Center’s billing and cash accounting management, including all services related to billing and accounts receivable functions related to administering bundles and processing claims. This role has a mission to provide industry leading revenue cycle management through a value-based culture, resulting in exceptional performance. This managerial role will function within the Center’s policies and procedures, support the values, vision, and mission of SCA Health and the Center. This manager will have extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc. and is a top performer with an extensive knowledge of billing, collections. cash accounting, and reimbursement methodologies with the ability to effectively deliver results. On-going management and strategy will be required to maximize timely and accurate reimbursement for all specialties and financial classes through in-depth reporting and analysis using multiple information systems and portals, as well as the analysis of coding and billing practices to ensure accurate and appropriate billing procedures. Experience managing high claim volume in various stages of processing with successful results is required, as well as supervisory experience overseeing complete process and procedures in their entirety and identifying quality and process improvements.

  • Pull information from the system and enter the charges, make any adjustments, utilize internal databases, optimize the codes and submit the claim electronically or by paper.

Accountabilities/Responsibilities:

  • Primary functions are credit balance management, patient balance resolution and non-patient (insurance) resolution.
  • Pull information from the system and enter the charges, make any adjustments, utilize internal databases, optimize the codes and submit the claim electronically or by paper
  • Prepares and completes claims for commercial insurance companies, third party organizations and/or government or self-payers
  • Complete billing rejections and make corrections as needed
  • Follow up on pending claims and work them to resolution
  • Review the variance report and identify and report any trends found
  • Consistently achieve defined metrics
  • Accurate and timely follow up and resolution for all accounts receivable.
  • Maximize facility reimbursement.
  • Understands each payer contract and will utilize to ensure payments received are correct.
  • Understands and can explain the Explanation of Benefits received from any payer.
  • Works closely with payer provider relations representatives.
  • Has thorough knowledge of ASC Allowable procedures.
  • Handles contracted and non-contracted; HMO, PPO, EPO, POS, Worker’s Com., self-pay and third-party reimbursement issues.
  • Effectively and independently handles second level reimbursement issues, contracted and non-contracted denials for serviced before and after procedures.
  • Works all denials and corrected claims collaborating with collections teammates, Business Office Manager, insurance payers and/or patients on past due accounts.
  • Follow center policies, procedures, and best practices for resolution and reassignment of accounts.
  • On-going management and strategy will be required to maximize timely and accurate reimbursement for all specialties and financial classes through in-depth reporting and analysis using multiple information systems and portals, as well as the analysis of coding and billing practices to ensure accurate and appropriate billing procedures
  • Experience managing high claim volume in various stages of processing with successful results is required
  • Supervisory experience overseeing complete process and procedures in their entirety and identifying quality and process improvements
  • Handle high level issues to resolution.
  • Monitor and or complete special projects and ensure deadlines are met.
  • Possess basic knowledge of medical terminology and health insurance billing.
  • Have ability to communicate effectively with patient, physicians, and other teammates.
  • Assist other Leads with supervisory duties in their department when they are away.
  • Attend all meetings
  • Assist with business office processes being performed, identify trends and recommend process improvements.

Qualifications

  • Bachelor's degree preferred
  • 3 years’ experience in related field or proven experience with SCA Health required
  • Basic knowledge of accounting procedures, including cash accounting, with a background in a medically related environment
  • Extensive experience in accounts receivable and medical billing
  • Demonstrate proficient knowledge in MS Office with strong computer skills
  • Must have managerial experience or demonstrate exceptional leadership within a team
  • ASC, healthcare experience required
  • Medical terminology knowledge required
USD $73,898.00/Yr. USD $85,000.00/Yr.

679e492d1e159717a7868803

PI900fffbc435a-37641-36623776


Apply Now