PFS Manager

March 29, 2024 |

Department: Business Office

Status/Schedule: Full Time

Shift: Days

Location: Hartford, KY

For more information contact: Jennifer Daugherty, jdaugherty@ochcares.com

Qualifications:

  • Educational Preference: 2-year associate degree
  • Experience: Preferred 5 years
  • Additional requirements:
    • Must be organized
    • Excellent attendance

Job Description:

  • Responsible for the hospital AR performance and AR days reported

  • Monitoring AR follow-up staff performance and adjusting methods accordingly to increase collections

  • Reviewing aged AR for each employee and addressing any issues there may be

  • Signing off on account adjustment requests and refund requests

  • Communicating with insurance payer representatives via meetings or emails about recurring problems in billing or claims processing to resolve ongoing claim/billing issues to maximize collections

  • Ensuring payers are adhering to contract terms for reimbursement

  • Sending annual CMS Fl rate letters to Medicare and Medicaid payers for loading in their claims processing systems and monitoring thereafter to ensure reimbursement is correlating with appropriate rates

  • Researching and staying up to date on insurance payer medical policies and reimbursement policies, sharing them with business office follow-up staff Updating insurance tables in CPSI, including adding new financial classes, or updating information for existing financial classes

  • Administering and Monitoring TruBridge RCM claims billing and management software, including denial management and contract management modules Entering situations with CPSI and support cases with TruBridge RCM to correct errors and resolve various patient accounting issues

  • Creating edits in the TruBridge RCM software to increase efficiently in billing

  • Enrolling in claim submission and remittance retrieval for all payers where available

  • Creating and importing claim batches from CPSI into RCM and correcting errors on unclean claims in the work queue before to submitting the payers

  • Assisting other staff with billing and importing claims and with correcting errors in their work queues

  • Appealing denials on claims on which staff is having trouble collecting

  • Submitting complaints to the KY Department of Insurance when payers are not abiding by reimbursement regulations and contracted processes

  • Helping with follow-up duties as needed Registering Hospice accounts, new and recurring Keying Hospice 82A Notice of Elections and 82B revocations to the Medicare DDE system in a timely manner

  • Completing a weekly calculation and reporting of DNFB AR days (Discharged Not Final Billed) Completing monthly reports and submitting them to the accounting department and CFO as needed at each month end, including Medicare bad debt log, Pain ManagementReport, Medicare SNF days, ER visit count report for reconciliation, Average Denials to Net revenue, etc.

  • Submitting quarterly revenue information to Pain Management Group Tracking and collecting on all Zulresso infusion accounts

  • Tracking and collecting on all neurostimulator implant account

  • Sending invoice to KY Cancer Link Colon Cancer Screening program for patient procedure accounts qualifying under the program

  • Responsible for billing and collections of invoices to various contract billing companies for employee drug screens and new employment services

  • Participating in interviews of new employees in the Business Office

  • Training or assisting in the training of new employees

  • Setup of new staff workstations, including ordering desks, supplies, etc. and coordinating general setup of computer applications

  • Administrator of all payer portal web accounts

  • Create new staff accounts and reset existing login credentials for all users throughout Ohio County Healthcare

  • Training on the payer portal websites for all staff hospital wide

  • Reviewing/authorizing employee time corrections and errors and benefit time requests while monitoring attendance of hospital business office staff

  • Administering disciplinary action when necessary, according to hospital policies

  • Finding coverage for positions in the business when staff is out

  • Frequently covering for critical positions in the business when staff is out, and no other coverage is available

  • Completing employee annual evaluations, job descriptions and competency checklists

  • Answering questions from all business office staff regarding various tasks and processes, claims denials, job functions, etc.

  • Troubleshooting technical applications and finding resolution for various issues such as computer and website errors, printer errors, etc.

  • Organizing Fire and Evacuation drills for downtown business office and logging findings appropriately

  • Attending training webinars from Ovation and other learning sites

  • Attending hospital revenue cycle meetings and other leadership meetings

  • Answering various questions and completing multiple requests from other department leaders and staff

  • Gathering and submitting data files to Blue & Co. for annual KY DSH reports and surveys

  • Gathering revenue and reimbursement data for various reporting purposes including various financial audits, cost reports, and other financial reporting throughout the year at the request of the Business Office Director, Accounting department and/or CFO Involved in any legal matters brought forth by the hospital regarding insurance payer reimbursement

  • Representing the business office in assisting with new hospital projects/services

Ohio County Healthcare

Ohio County Healthcare is a non-profit Joint Commission accredited health system which provides a wide range of hospital, primary care and specialty physician services.

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