At Stony Brook Medicine, the Supervisor for Governmental Billing and Follow-up will oversee Medicare and Medicaid billing and accounts receivable follow-up in the Hospital's Business Office. Reporting to the Senior Manager of Patient Financial Services (PFS), the Supervisor will lead the hospital's Governmental Billing & Follow-up area to ensure the effective billing and collection of insurance receivables. The Supervisor will work to ensure compliance with applicable CMS and NYS Medicaid regulatory guidelines and established departmental policies and procedures. They will develop and optimize claims resolution work flows and work queues, train and schedule staff and monitor the unit's work quality and productivity. They will review and report unbilled claims, aged A/R and denial trends to management and as appropriate work with Patient Accounting leadership to resolve high dollar/high risk accounts.
Duties of a Supervisor for Governmental Billing & Follow Up may include the following but are not limited to:
Develops work flows, scripting and training to support Hospital Inpatient and Outpatient Medicare and Medicaid billing and follow-up.
Works with the Unit's Revenue Cycle Coordinator to develop staff education including job aides and training materials.
Develops and monitors work queues and staff productivity to ensure work volumes and staffing are aligned.
Audits staff work; provide education on best practice.
Analyze and reports on unbilled claims, payment issues, i.e. denials/trends, payments, etc.
Identifies issues and patterns regarding medical necessity / MUE edits and other claim scrubber edits.
Supervises resolution of complex claims including interim, ALC, LOA and benefits exhaust billing.
Acts as liaison between the Business Office and Internal Revenue Cycle Departments, i.e., Health Information Management (HIM Coding), Patient Access and Care Management.
Assists with all third party audits.
Completes internal audits on accounts receivable.
Serves as Subject Matter Expert for Governmental Billing and Collections. Keeps staff and Management updated on all relevant CMS or NY Medicaid policies and regulations.
Assists PFS Management in reporting and special projects.
Works collaboratively with I.T. and PFS technical resources to develop and test billing and follow-up systems specifications and configuration.
Maintains policies and procedures for the Unit.
Bachelor's Degree + 3 years' experience performing Acute Care Hospital billing and/or follow up, or in lieu of degree 5 years' experience performing and/or supervising Acute Care Hospital billing and follow up.
Expert knowledge of governmental and non- governmental healthcare facility claim reimbursement methodologies.
Expert knowledge of inpatient and outpatient billing /follow- up requirements (UB-04, 837i and 835), specifically how claims information impacts and drives reimbursement.
Experience working with CPT / HCPCs and ICD-10 codes.
Proficiency in MS Office Suite; including Excel, Word, and OneNote.
Excellent written and verbal communication skills.
Master's Degree or professional licensure.
Experience working with Cerner Invision Patient Accounting.
Experience working in the Medicare FSS, DDE System.
Supervisory and Training experience in the Governmental Billing and/or Follow-up areas of an Acute Care Hospital.
Medical Coding Certification through the American Academy of Professional Coders (AAPC) and/or the American Health Information Management Association (AHIMA).
Proficiency with visualization software (Tableau, MS Power BI, etc.).
Special Notes: Resume/CV and cover letter should be included with the online application.
In accordance with the New York State Department of Health (DOH) regulation that all hospitals and nursing homes "continuously require all personnel to be fully vaccinated against COVID-19," Candidates who are not already partially vaccinated must obtain the first dose of the vaccine within three (3) calendar days of acceptance of conditional job offer and must obtain any subsequent doses in accordance with the vaccine protocol, including booster vaccines. Candidates who are partially vaccinated, but not yet fully vaccinated, must complete their vaccination series within three (3) calendar days of job offer or in accordance with vaccine manufacture protocol, whichever comes later.
The regulation also includes those who may be affiliated with or interact with employees of a hospital or nursing home. The regulation allows for limited exemptions with reasonable accommodations, consistent with applicable law.
Posting Overview: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. Candidates are advised on the application that for full consideration, applications must be received before the initial review date (which is within two weeks of the posting date).
If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date. Please note, that if no candidate were identified and hired within 90 days from initial posting, the posting would close for review, and possibly reposted at a later date.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions maybe subject to changes in pass days and shifts as necessary.
This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
This function/position maybe designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Prior to start date, the selected candidate must meet the following requirements:
Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services*
Complete electronic reference check with a minimum of three (3) professional references.
Successfully complete a 5 panel drug screen*
Successfully complete a Background Check investigation.
Provide a copy of any required New York State license(s)/certificate(s).
Failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
*The hiring department will be responsible for any fee incurred for examination.
Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.
If you need a disability-related accommodation, please call the University Office of Equity and Access at (631)632-6280.
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Official Job Title:TH Patient Accounting Specialist
:Administrative & Professional (non-Clinical)
Department/Hiring Area:Patient Accounting
:Day ShiftShift Hours:8:30am-5:00pmPass Days:Sat, Sun
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