PRINCIPAL DUTIES AND RESPONSIBILITIES:
Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers and one another.
Billing Operations Management
Oversees the daily operations of the Neurosurgery professional billing function.
Ensures timely and accurate claim review, submission, payment reconciliation, and account follow-up.
Monitors accounts receivable and denial work queues to ensure appropriate and timely resolution.
Reviews and verifies patient account information against insurance plan requirements, reimbursement policies, and billing regulations.
Researches and investigates complex claims, high-dollar accounts, underpayments, denials, and reimbursement issues.
Coordinates billing activities across multiple providers, locations, and payer types to ensure consistency and compliance.
Monitors billing performance indicators, including claim submission timeliness, denial rates, aging accounts receivable, collection performance, and reimbursement trends.
Identifies root causes of claim denials and payment delays and implements corrective actions to improve revenue cycle outcomes.
Collaborates with Patient Financial Services and Revenue Cycle leadership to resolve escalated reimbursement issues.
Assists with developing and implementing billing policies, procedures, and workflow improvements designed to increase efficiency and reduce revenue leakage.
Participates in revenue cycle initiatives and operational improvement projects.
Provides oversight and guidance regarding CPT, HCPCS, and ICD-10 coding and reimbursement practices.
Reviews billing edits, coding-related denials, and documentation issues to support compliance with regulatory and payer requirements.
Collaborates with providers and clinical staff to resolve coding, documentation, charge capture, and surgical authorization questions.
Maintains current knowledge of coding updates, payer policies, reimbursement methodologies, and industry practices.
Ensures billing operations comply with applicable federal, state, payer, and organizational requirements.
Patient and Payer Relations
Serves as an escalation point for complex patient account and billing inquiries.
Communicates with commercial and governmental payers regarding claim disposition, reimbursement concerns, and billing disputes.
Works collaboratively with payer representatives to resolve outstanding claims and reimbursement issues.
Promotes a high level of customer service and responsiveness in patient, provider, and payer interactions.
Provides direct supervision of Senior Billing Specialists and other assigned billing staff.
Assigns, prioritizes, and monitors workload to ensure departmental goals, quality standards, and performance expectations are achieved.
Participates in recruitment, onboarding, orientation, scheduling, and training activities.
Provides ongoing coaching, feedback, mentoring, and development opportunities.
Fosters a positive, collaborative, and accountable work environment.
Reviews and analyzes billing, reimbursement, denial, accounts receivable, and productivity reports.
Prepares operational reports and presents findings and recommendations to leadership.
Uses data to identify trends, process improvement opportunities, and operational or compliance risks.
Supports budgetary and operational planning activities as requested.
Maintains the confidentiality of patient, employee, and organizational information.
Participates in departmental meetings, committees, and special projects.
Performs other related duties as assigned