Director Insurance Recovery-Corporate Business Office Coding

GENERAL SUMMARY:

The Director of Insurance Recovery – CBO Coding is responsible for the effective

functioning of the Corporate Insurance Billing office across the multi-facility integrated

healthcare delivery system, which includes all insurance billing associated with Henry

Ford Health (HFH) hospitals, outpatient clinics employed physicians, and PSAs. This

position focuses on those workflows that require coding interpretation to properly submit

or modify the claim for appropriate reimbursement.

This position leads through sharing knowledge, motivation and empowerment of

insurance billing office team to provide high quality services, which meet or exceed

customer expectations. Through collaboration with members of the team and revenue

cycle leadership, identifies departmental and business unit priorities, establishes goals

and implements strategies designed to foster a culture of innovation, employee

engagement, patient satisfaction, and exceptional business performance.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

Daily Operations

·       Responsible for all insurance billing functions to include claims processing, payer follow up and accounts receivable management.

·       Collaborates with other Revenue Cycle teams to provide feedback to areas to reduce denials, preventable losses and increase claims payment from payers.

·       Collaborates with other HFH coding departments to develop effective workflows across front-end and back-end process, providing feedback loops, and participates in improvement opportunities.

·       Coordinates resolutions of exceptions across multiple work queues such as pre-bill, claim scrubber, payer rejection, etc., utilizing the workstream philosophy with a focus on revenue codes, CPT/HCPCS codes, and modifiers edits and denials.

·       Maintains revenue cycle accountability to the business units.

·       Prepares annual budget and manages expenses and staffing levels.

·       Partners with key leaders across the system to enhance the insurance billing experience.

·       Recruits and develops leaders to build a culture for high performance and engaged workforce.

·       Responsible for the continued integration and management of consistent processes, policies, and technology.

·       Oversees/directs the development of policies and procedures for the department.

·       Participates in data collection for performance measures, investigates opportunities and implements solutions for optimization.

·       Demonstrates belief in the mission of Henry Ford Health through the ability to articulate, interpret, and incorporate its mission into departmental goals and objectives.

·       Supports the standards set forth in the HFHS Code of Conducts by creating an atmosphere of commitment to legal and ethical standards.

·       Establishes priorities and long and short-term strategic goals of the department with the assistance of the management team.

·       Ensures staff is aligned with the goals and objectives related to Revenue Cycle for the organization.

·       Leads/ participates in various committees related to regulatory changes, performance improvement and compliance.

·       Ensures that information systems support current and future needs of the department.

·       Works closely with information technology in transition planning including, but not limited to, testing, installation and education of staff to produce and maintain high quality data integrity.

·       Creates and manages strategic partnerships with vendors and third-party systems to ensure optimization of costs and quality.

·       Monitors performance of external vendors with monthly performance metrics and standards compared to benchmarks.

·       Partners with key leaders across the system to ensure accurate accounts receivable recording activities in accordance with generally accepted accounting principles.

·       Performs other related duties as assigned.

 Compliance

·       Responsible for maintaining regulatory compliance with external agencies and state and federal regulations.

·       Ensures staff are kept informed and educated on process and regulatory changes.

·       Works with risk management, legal counsel, compliance office, administrative staff, key departments, providers, and committees to ensure that the organization maintains appropriate compliance including privacy, security and confidentiality policies, procedures, forms, coding, information notices, and materials that reflect current organizational practices and regulatory requirements.

 Quality Management

·       Is the guiding force behind the identification, establishment and maintenance of quality improvement activities related to insurance billing services.

·       Promotes the principles of quality improvement and utilizes the results of quality improvement activities to identify areas where change would benefit the team and its customers.

·       Works with appropriate System and revenue cycle leadership, ensures insurance billing services representation and participation in appropriate external collaboration, think tanks, benchmarking groups, best practices, other initiatives at the local, state, and national levels.