SBO Reimbursement Coordinator

Time Type:Full timeHours per Pay Period:80Shift:Day Shift 8-80Minimum: $63,225.00 USDMaximum: $85,539.00 USD(This represents the rate for an individual with significant experience in this job in a full-time 40 hour per week position)Department:Revenue CycleCurrent Bay Area Hospital Employee: If you are a current Bay Area Hospital employee, please apply through the Workday internal career site.

The future looks bright at Bay Area Hospital, and we are always searching for quality people to join our team. We offer a great atmosphere, competitive pay, a wide array of benefits, and many growth opportunities for our employees.

Job Description:Coordinator SBO ReimbursementThis position is responsible for building and maintaining the EHR contract modules in Epic for the Single Billing Office (SBO) at Bay Area Hospital. The coordinator is responsible for system build, monitoring and working claim variances and collaborating with payers to resolve reimbursement related issues. This position also manages payer plan records and remit code mapping in collaboration with the other Community Connect partners.

EXPECTATION FOR ALL EMPLOYEESSupport the organization’s mission, vision and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all laws and regulations affecting Bay Area Hospital. Be familiar with and adhere to the Code of Conduct and support the Bay Area Hospital Compliance Program. Effective communication skills and the ability to work effectively with people from various backgrounds are critical. POSITION SUMMARYThis position is responsible for building and maintaining the EHR contract modules in Epic for the Single Billing Office (SBO) at Bay Area Hospital. The coordinator is responsible for system build, monitoring and working claim variances, and collaborating with payers to resolve reimbursement related issues. This position also manages payer plan records and remit code mapping in collaboration with the other Community Connect partners. PRINCIPLE DUTIES AND RESPONSIBILITIESAccurately interprets contract reimbursement rates and methodology for build purposesBuilds and customizes payer plan specific contracts, including various reimbursement methodologies within EpicEnsures adequate testing, quality assurance, and documentation of contract build in EpicResponsible for tracking contract renewals and amendmentsPerforms continual maintenance and updating of existing contracts to reflect current reimbursement rates and methodologies; builds new contracts as neededPerforms ongoing testing and corrects build errors based on feedback from end usersWorks collaboratively with payers and departments to resolve errors, issues and disputesConducts audits and completes testing of estimated contractual reimbursementResponsible for facility, clearinghouse payer and remittance enrollmentsWorks bad debt file sent from IT on a monthly basisWorks low yield accounts from accounting on a monthly basisCompiles daily, weekly and monthly statistical reports necessary for successful management of Revenue Cycle Operations and AR ManagementEvaluates material variances and trends to identify and resolve root causesTrends professional fee variances and works directly with health plans to resolve issuesPrepares analysis related to the financial performance of existing payer contracts in order to identify opportunities for improvement and recommend areas for improvementSupports payer contracting proposed negotiations by modeling payor contracts to identify effective rate proposalsWorks collaboratively with other revenue cycle and hospital departments, external agencies, vendors, payers and Community Connect partners, communicating effectively in both written and verbal formats with staff, peers, all levels of management, and all encounters both inside and outside the organizationProvides oversight, prioritizes workflow and monitors performance to support key performance indicatorsCollaborates with Patient Access, HIM, Revenue Integrity and Contract Management to support revenue cycle functions and identify opportunities for improvement; implements performance improvement plansPromotes and supports the achievement of organizational goals and revenue cycle objectivesProvides and promotes professional, efficient and congenial customer service through all communication and interaction with customersEnsures department compliance with hospital policies, all applicable federal and state laws, regulatory requirements and payer guidelinesAudits and manages all collection and write-off activities, ensuring adherence to guidelines and policiesOversees third party vendor performance to meet performance expectations for assigned workPlans for and oversees the implementation of new software as well as maintenance, ensuring existing software processes meet the needs of the organizationServes as a contact point for reimbursement questions from clinical and non-clinical departmentsCollaborates with Community Connect team to maintain Payer/Plan tables in EpicMaintains knowledge of department and organizational structure, workflow and operating proceduresAttends training and completes online training as assignedParticipates in and completes department and organizational projectsUnderstands procedures for all emergency situations and responds appropriatelyOther duties as assigned SKILLS AND ABILITIESAble to understand and interpret payer contracts; research, collect and analyze contract information as requiredAbility to accurately build contracts into the contract management system and Epic contract applicationsMust be able to calculate and audit expected reimbursement in order to determine accuracy of paymentPossess specific knowledge of Third-Party Healthcare Arrangements and ability to apply that knowledgeWorking knowledge of remittance codes, including CARC and RARC codes that can impact adjustments and denialsKnowledge of 837i and 837p electronic claim formatsDemonstrates working knowledge in applicable systems, including but not limited to Epic, Experian, OnBase, Excel, Word and TeamsDemonstrates dynamic leadership skills to promote and support the achievement of overall organizational goals and specific revenue cycle objectivesFamiliarity with industry best practices and standardsAbility to translate complex problems and conceptsEffective and professional communication skills, both verbal and writtenGood interpersonal skills and ability to communicate with all levels of managementExcellent team building and management skillsOrganizational skills that promote the ability to work well without direct supervision, manage time effectively, and appropriately prioritize multiple assignments to meet project deadlinesEffective collaboration and communication with a variety of individuals, both internal and external, including multidisciplinary teamsEnsures recommendations support adherence to all federal, state and other regulatory requirementsCommunicates effectively with all constituents and keeps leadership informed of issuesDemonstrates ability to problem solve, work independently and as part of a teamDemonstrates initiative and exercises good judgment and effective critical thinking skillsFlexible; able to prioritize and address multiple responsibilities concurrently and meet deadlinesWorks effectively under stress and in frequently changing job requirements/situationsExhibits the ability to deal effectively interdepartmentally and with the publicExhibits the ability to maintain confidentiality, think and act independently with minimal supervisionFlexibility in job schedule to provide user support and advance project goalsMaintains regular, consistent and punctual attendance at the assigned job location EDUCATION/CERTIFICATIONS/LICENSES/DEGREESHigh school graduate or equivalentAssociate’s or Bachelor’s degree preferredCurrent Epic certifications or ability to gain certification within 180 days (6 months) required:Resolute Hospital Billing Expected Reimbursement Contracts AdministrationResolute Professional Billing Reimbursement ContractsHealthcare certification (AAHAM, NAHAM, HFMA), Epic Certification and/or training preferred EXPERIENCEMinimum of five years of work experience in healthcare revenue cycle, with a minimum of two years working with hospital payer contracts, reimbursement methodologies, coding, billing and claimsExperience with Epic, Experian, Craneware, Optum, 3M or other revenue cycle solutions software requiredProficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook and Excel), WebEx, Teams or other remote meeting/communication platformsProject management, technical implementations, and change management experience a plus GENERAL INFORMATIONUnion Affiliation: None The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities and job skills required. Physical/Mental/Environmental RequirementsRequires extensive sitting with periodic standing and walkingMay be required to lift up to 20 poundsRequires significant use of personal computer, phone and general office equipmentNeeds adequate visual acuity, ability to grasp and handle objectsNeeds ability to communicate effectively through reading, writing, and speaking in person or by telephoneMay require off-site travelEXPECTATION FOR ALL EMPLOYEESSupport the organization’s mission, vision and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all laws and regulations affecting Bay Area Hospital. Be familiar with and adhere to the Code of Conduct and support the Bay Area Hospital Compliance Program. Effective communication skills and the ability to work effectively with people from various backgrounds are critical. POSITION SUMMARYThis position is responsible for building and maintaining the EHR contract modules in Epic for the Single Billing Office (SBO) at Bay Area Hospital. The coordinator is responsible for system build, monitoring and working claim variances, and collaborating with payers to resolve reimbursement related issues. This position also manages payer plan records and remit code mapping in collaboration with the other Community Connect partners. PRINCIPLE DUTIES AND RESPONSIBILITIESAccurately interprets contract reimbursement rates and methodology for build purposesBuilds and customizes payer plan specific contracts, including various reimbursement methodologies within EpicEnsures adequate testing, quality assurance, and documentation of contract build in EpicResponsible for tracking contract renewals and amendmentsPerforms continual maintenance and updating of existing contracts to reflect current reimbursement rates and methodologies; builds new contracts as neededPerforms ongoing testing and corrects build errors based on feedback from end usersWorks collaboratively with payers and departments to resolve errors, issues and disputesConducts audits and completes testing of estimated contractual reimbursementResponsible for facility, clearinghouse payer and remittance enrollmentsWorks bad debt file sent from IT on a monthly basisWorks low yield accounts from accounting on a monthly basisCompiles daily, weekly and monthly statistical reports necessary for successful management of Revenue Cycle Operations and AR ManagementEvaluates material variances and trends to identify and resolve root causesTrends professional fee variances and works directly with health plans to resolve issuesPrepares analysis related to the financial performance of existing payer contracts in order to identify opportunities for improvement and recommend areas for improvementSupports payer contracting proposed negotiations by modeling payor contracts to identify effective rate proposalsWorks collaboratively with other revenue cycle and hospital departments, external agencies, vendors, payers and Community Connect partners, communicating effectively in both written and verbal formats with staff, peers, all levels of management, and all encounters both inside and outside the organizationProvides oversight, prioritizes workflow and monitors performance to support key performance indicatorsCollaborates with Patient Access, HIM, Revenue Integrity and Contract Management to support revenue cycle functions and identify opportunities for improvement; implements performance improvement plansPromotes and supports the achievement of organizational goals and revenue cycle objectivesProvides and promotes professional, efficient and congenial customer service through all communication and interaction with customersEnsures department compliance with hospital policies, all applicable federal and state laws, regulatory requirements and payer guidelinesAudits and manages all collection and write-off activities, ensuring adherence to guidelines and policiesOversees third party vendor performance to meet performance expectations for assigned workPlans for and oversees the implementation of new software as well as maintenance, ensuring existing software processes meet the needs of the organizationServes as a contact point for reimbursement questions from clinical and non-clinical departmentsCollaborates with Community Connect team to maintain Payer/Plan tables in EpicMaintains knowledge of department and organizational structure, workflow and operating proceduresAttends training and completes online training as assignedParticipates in and completes department and organizational projectsUnderstands procedures for all emergency situations and responds appropriatelyOther duties as assigned SKILLS AND ABILITIESAble to understand and interpret payer contracts; research, collect and analyze contract information as requiredAbility to accurately build contracts into the contract management system and Epic contract applicationsMust be able to calculate and audit expected reimbursement in order to determine accuracy of paymentPossess specific knowledge of Third-Party Healthcare Arrangements and ability to apply that knowledgeWorking knowledge of remittance codes, including CARC and RARC codes that can impact adjustments and denialsKnowledge of 837i and 837p electronic claim formatsDemonstrates working knowledge in applicable systems, including but not limited to Epic, Experian, OnBase, Excel, Word and TeamsDemonstrates dynamic leadership skills to promote and support the achievement of overall organizational goals and specific revenue cycle objectivesFamiliarity with industry best practices and standardsAbility to translate complex problems and conceptsEffective and professional communication skills, both verbal and writtenGood interpersonal skills and ability to communicate with all levels of managementExcellent team building and management skillsOrganizational skills that promote the ability to work well without direct supervision, manage time effectively, and appropriately prioritize multiple assignments to meet project deadlinesEffective collaboration and communication with a variety of individuals, both internal and external, including multidisciplinary teamsEnsures recommendations support adherence to all federal, state and other regulatory requirementsCommunicates effectively with all constituents and keeps leadership informed of issuesDemonstrates ability to problem solve, work independently and as part of a teamDemonstrates initiative and exercises good judgment and effective critical thinking skillsFlexible; able to prioritize and address multiple responsibilities concurrently and meet deadlinesWorks effectively under stress and in frequently changing job requirements/situationsExhibits the ability to deal effectively interdepartmentally and with the publicExhibits the ability to maintain confidentiality, think and act independently with minimal supervisionFlexibility in job schedule to provide user support and advance project goalsMaintains regular, consistent and punctual attendance at the assigned job location EDUCATION/CERTIFICATIONS/LICENSES/DEGREESHigh school graduate or equivalentAssociate’s or Bachelor’s degree preferredCurrent Epic certifications or ability to gain certification within 180 days (6 months) required:Resolute Hospital Billing Expected Reimbursement Contracts AdministrationResolute Professional Billing Reimbursement ContractsHealthcare certification (AAHAM, NAHAM, HFMA), Epic Certification and/or training preferred EXPERIENCEMinimum of five years of work experience in healthcare revenue cycle, with a minimum of two years working with hospital payer contracts, reimbursement methodologies, coding, billing and claimsExperience with Epic, Experian, Craneware, Optum, 3M or other revenue cycle solutions software requiredProficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook and Excel), WebEx, Teams or other remote meeting/communication platformsProject management, technical implementations, and change management experience a plus GENERAL INFORMATIONUnion Affiliation: None The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities and job skills required. Physical/Mental/Environmental RequirementsRequires extensive sitting with periodic standing and walkingMay be required to lift up to 20 poundsRequires significant use of personal computer, phone and general office equipmentNeeds adequate visual acuity, ability to grasp and handle objectsNeeds ability to communicate effectively through reading, writing, and speaking in person or by telephoneMay require off-site travelCompensation Grade:FCompensation Grade Profile:F - SalariedBay Area Hospital is an Equal Opportunity Employer.

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