Assistant Manager-Billing, Coding and Denials
hace 22 días
Blanding
Job Description Job Description Culture Statement: At Blue Mountain Hospital, we are committed to a culture of excellence, empowerment, accountability, and affirmative communication. Value Statement: Blue Mountain Hospital strives to exemplify values of Excellence, Integrity, Respect, Cultural Sensitivity, Compassion, Accountability, Stewardship and Collaboration. Vision Statement: Blue Mountain Hospital vision is to be the standard for rural hospitals. Mission Statement: Blue Mountain Hospital is committed to providing an atmosphere of excellence in healing, quality physician care and inspired employees. Occupational Title: Assistant Manager -Billing, Coding and Denials Department: Business Office/Revenue Cycle Reports To: Denise Arthur Facility Location: Blue Mountain Hospital -Cedar Mesa Position: Full-time Description: The Revenue Cycle Assistant Manager supports the Director Of Revenue Cycle in overseeing Billing, Coding, Health Information Management (HIM), and Denials Management. This role ensures accurate coding, compliant documentation, timely claims submission, effective denial resolution, and optimized reimbursement in a Critical Access Hospital (CAH) environment. The Assistant Manager serves as a working leader and staff advocate, providing guidance, mentoring, and support to revenue cycle team members. This role monitors performance metrics, assists with process improvements, addresses staff needs, and ensures revenue integrity while maintaining compliance with Medicare, Medicaid, PRC, and commercial payer regulations. Essential Duties and Responsibilities Billing Oversight * Oversee hospital and professional billing processes to ensure timely and accurate claim submission. * Monitor accounts receivable performance, aged AR, and clean claim rates. * Ensure compliance with Medicare, Medicaid, commercial, and secondary payer requirements. * Assist with payer enrollment, billing edits, and system optimization. Coding & Documentation Integrity * Provide oversight of inpatient, outpatient, swing bed, and professional coding functions. * Ensure accurate assignment of ICD-10-CM, CPT, HCPCS, and revenue codes. * Monitor DNFB and coordinate timely chart completion and coding workflows. * Collaborate with providers to improve documentation accuracy and reduce medical necessity denials. * Support audit response and coding compliance initiatives. Health Information Management (HIM) * Oversee medical records workflows including chart completion, record retention, release of information, and scanning/indexing processes. * Ensure compliance with HIPAA and state/federal record retention requirements. * Maintain data integrity within the electronic health record (EHR). * Support chart audits and regulatory readiness activities. Denials Management & Revenue Integrity * Lead denial tracking, trending, and root cause analysis efforts. * Develop and implement corrective action plans to reduce avoidable denials. * Coordinate appeals processes and monitor appeal success rates. * Collaborate with clinical departments to address documentation gaps impacting reimbursement. * Support denial prevention initiatives through staff education and workflow improvements. Leadership & Staff Development * Provide daily operational guidance and supervision to Billing, Coding, HIM, and Denials staff. * Assist with hiring, onboarding, cross-training, and performance evaluations. * Maintain updated policies and procedures. * Promote a culture of accountability, collaboration, and continuous improvement. Key Performance Indicators: Days in Accounts Receivable Denial Rate and Appeal Success Rate DNFB Clean Claim Rate Coding Accuracy Rate Aged AR >90 days Timely medical record completion Requirements Experience, Training, and Qualifications needed to perform the job: Required: * Active AAPC certification (CPC, CPB, CPPM, or specialty credential) or Associate degree in a Healthcare related field. * Minimum two years of experience in hospital revenue cycle operations. * Experience in hospital billing, coding, health information management, or denials management Preferred: * Experience in a Critical Access Hospital * Knowledge of Medicare cost-based reimbursement methodologies * Knowledge of Purchased/Referred Care (PRC) programs * Additional certification such as CCS, RHIT, RHIA, or CRCR * Prior supervisory or lead experience General Requirements: In addition to the specific duties listed above, the Employee is required to do the following: * Any tasks, projects, or actions that are reasonably within the scope of the Employee’s position or employment, which the Employee’s supervisor, any member of BMH’s management, or BMH’s administration team—asks of the Employee. Tasks, projects, or actions are “reasonably within the scope” of the Employee’s employment or position unless the same are so far removed therefrom that no legitimate argument can be made that such tasks, projects, or actions are in any way related to BMH or the Employee’s employment or position within BMH. * Act as professionally as should normally be required in a medical organization. This shall include giving all appropriate respect and deference to licensed medical providers and behavioral health providers (hereafter jointly referred to as “Providers”). Providers include, but may not be limited to physician assistants, nurse practitioners (or similar), and Physician Assistants. * Keep all BMH business and patient information strictly confidential and to adhere to all other BMH confidentiality policies and procedures, as well as all laws affecting confidentiality. * Refrain—whatsoever—from intentionally, purposely, knowingly, or negligently engaging in any conduct, actions, or speech that may cause concern, apprehension, confusion, or annoyance on the part of any BMH patient toward BMH as an organization or any BMH employee. * Work congenially and cooperatively at all times with all other BMH employees. This includes maintaining a pleasant demeanor and attitude and executing position duties and administration’s/management’s other requests in a timely manner, diligently, and with a positive attitude. This requirement further includes refraining from personally degrading any other person or BMH employee. As part of this requirement, the Employee must refrain from engaging in gossip about any BMH employees and/or patients. * Communicate complaints about BMH, its policies, procedures, managers, administrators, and/or other employees—only to and through the appropriate BMH channels, which are limited to BMH’s management chain of command. No complaints, judgments, or degrading comments about BMH, its policies, procedures, managers, administrators, and/or other employees—should be shared with anyone other than the appropriate persons within BMH’s management chain of command who have the ability to work to remedy any related problems. Unless the Employee’s direct supervisor is part of the problem or complaint—problems and complaints should first be voiced to the Employee’s direct supervisor and upward therefrom through BMH’s internal management chain of command as appropriate and necessary. It is an absolute dereliction of this duty by the Employee if the Employee ever—directly or indirectly (in conjunction or planning with others)—makes complaints or problems publicly known to anyone other than BMH’s management team or administrative team (neither include BMH Board Members). * If applicable (having access to), check the Employee’s BMH email no less frequently than once daily. * Absolutely refrain from communicating or releasing any “Private BMH Information” to the media and/or non-BMH persons or entities—without formal approval to do the same by BMH’s CEO. “Private BMH Information”, for purposes of this requirement, includes: (1) all information that requires confidentiality pursuant to any BMH policies or procedures; (2) all information that is protected by HIPAA or other applicable laws; (3) all information relating to BMH’s internal business workings, strategies, or plans; and (4) all information relating to any BMH employee or contractor. This requirement remains applicable and shall stand regardless of whether the information being requested is of a private or public nature—if the information sought fits any of the above listed types. Finally, this requirement remains applicable at all times, including when the Employee is off duty or away from BMH’s premises. We offer the opportunity to work with a dynamic team providing care to medically underserved communities. BMH hires in accordance with NPEA standards.
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