DGM - Billing Operations

Job Purpose:

The overall responsibilities for this job are to ensure client satisfaction and retention on current accounts and to help grow existing ones by identification of opportunities for enhancing services offered and ensuring the operational performance standards are met. He/she also directs and manages all activities that relate to creating a culture of quality. He/she shall be responsible for leading Billing Operations (Medical Billing & Provider Reimbursement)'s daily operations, ensuring optimal productivity, quality, and compliance with healthcare regulations. This role is critical for driving continuous improvement, resolving issues, and enhancing overall operational efficiency.

Role Description:

Responsible for the overall direction, coordination, and evaluation of the teams under management. Understands and demonstrates core values and Leadership Principles. Carries out supervisory and management responsibilities in accordance with the organization's policies and procedures. Mentors others in developing Leadership behaviors. Works with the Head-of-Department, RCM Operations to determine strategy to achieve overall organizational goals. Shapes the direction of the team, keeps them focused and motivated to deliver the right results. Solves complex client service issues by proactively identifying and eliminating root cause barriers to accuracy, productivity, and quality. Maximizes resources for the greater good of the organization. Lead and able to manage large teams (>=1,000 FTEs) to ensure efficient and seamless functioning of all operations. Maintain cost effective and stable workforce to absorb volume efflux/influx. Implement strong governance to address all processes within Billing Operations sub-department. Evaluate any and all training programs qualitatively and quantitatively through feedback and surveys. Good understanding of Billing Operations (Medical Billing & Provider Reimbursement) standards and methodologies. Excellent Team Management, Inter-Departmental Collaboration & Communication skills.

Key Deliverables:

Operations Management:

- Daily Oversight: Plan, monitor, and evaluate the performance of the entire team, ensuring that production targets and quality standards are met.

- Schedule Coordination: Ensure that daily schedules are adhered to; communicate with RCM Head of Department and other stakeholder about any challenges that may hinder deadlines.

- Workflow Optimization: Identify operational priorities and workflow challenges; adjust staff assignments to maintain a consistent workflow.

- Ensure alignment of service quality parameters to the departmental metrics as well as those SLAs as defined by the organization and clients.

- Collaborate on Operations dashboards (Tableau, DSS, Project Health, EWS) and ensure timely reporting to the Head of the Department/Other Management stakeholders.

- Identify, assess, and implement cost control measures across teams/processes.

Policy Development:

- Process Improvement: Assist in the development and revision of operational policies and procedures to enhance workflow efficiency.

- Client Understanding: Develop a comprehensive understanding of workflows, procedures, and specific requirements for every client.

Training and Development:

- Staff Training: Provide training and support to Associates on best practices in billing and provider reimbursement processes.

- Performance Reviews: Conduct regular performance evaluations, offering feedback and coaching to promote professional growth.

Issue Resolution:

- Query Management: Resolve queries and conduct thorough account reviews to ensure accuracy in billing and collections.

- Denial Management: Demonstrate expertise in denial management, including understanding of Medicare, Medicaid, and ICD and CPT coding, to effectively address and resolve denials.

Communication and Reporting:

- Periodical Updates: Ensure timely sending of acknowledgment emails regarding periodical updates to relevant stakeholders.

- Data Analysis: Analyze data to identify payer issues and challenges; implement solutions to address these concerns.

- Collaborate on Operations dashboards (Tableau, DSS, Project Health, EWS) and ensure timely reporting to the RCM Operations Head as well as our Bedford clients.

Team Engagement:

- Ensure timely preparation and review of goals and development plans for all employees within the team. Ensure accurate handling and completion of progress reviews on performance and development plans within agreed timescales and provide ongoing feedback to all managers within Billing Operations.

- Engagement Initiatives: Foster team engagement and work towards reducing absenteeism and turnover.

- Lead Communication: Serve as the primary contact for internal and external communications related to revenue cycle processes.

- Feedback Loop: Provide feedback on project performance and suggest enhancements based on team experiences.

- To provide strategic guidance to the Operations managers to ensure service delivery is within the defined SLAs.

Performance Management:

- Consistently meet predetermined metrics to achieve business objectives and customer SLAs and ensure contingency plans are in place for all services to include business recovery plans.

- Escalation Point: Act as the first level of escalation for operational issues, addressing concerns promptly and effectively.

People Related:

- Create a high performance, fair and exciting work environment that provides motivation and development opportunities for the teams.

- Ensure sharing of knowledge and best practices within the company and counsel managers to enhance performance and arrest attrition. Motivate and develop managers to include specific attention to individual development.

- Handle all employee related escalation if intervention required.

Experience & Qualifications:

- 16+ years of relevant experience.

Knowledge Skill Sets:

- Experiential understanding of Lean Six Sigma methodologies is a plus.

- Excellent interpersonal skills.

- Proven analytical skills in understanding and interpreting quantitative data and providing clear output to identify trends, interpret findings, draw insights, and formulate recommendations.

- Excellent Team Management, Inter-Departmental Collaboration & Communication skills.

- In-depth knowledge of best practices in management and governance.