Financial Specialist III - Revenue Management

Supports revenue and reimbursement billing, collections, tracking of all payers for CSB services for Revenue Management Team. Supports revenue and reimbursement billing, collections, tracking and reporting over $30 million in client and third-party fee revenues for the community service board.

Under the general direction of the Revenue Cycle Manager, this position supervises a team of professional staff on the fiscal team for the Fairfax-Falls Church Community Services Board (CSB). Performs and oversees various financial functions, including data analysis, monthly revenue metrics presentations, and reconciliations. Key responsibilities include developing reports, monitoring trends, analyzing data to assist CSB's revenue cycle manager in data driven decision making and strategic planning. Supports day-to-day billing operations and the self-pay collection related activities to ensure that all the information provided for billing is accurate and timely. Identifies areas to improve the revenue cycle, such as evaluating patients facing claims and medical billing functions to enhance revenue for each category. Assists in developing and communicating billing policies and procedures to ensure the timely filing of medical claims and to meet clean claim targets. Provides oversight into insurance payment receipts to include banking and cash postings. Focuses on insurance denial processes and oversees the appeal process as appropriate to avoid delays in revenue collections and to maximize revenue generation. Assists revenue cycle manager in managing accounts receivables, monitors adjustments and assesses write-off processes. Identifies and resolves operational and system issues and troubleshoots effectively. Maintains revenue management dashboard with defined key performance index metrics. Keeps abreast of current knowledge of changes in compliance standards, payer policies and state/federal regulations concerning coding, billing, and reimbursement processes. Supports the coordination effort for responses to inquiries from internal auditors regarding billing and collection practices as well as revenue reconciliation.

This role is responsible for:

• Monitoring, tracking, and evaluating staff productivity and performance.
• Ensuring quality assurance on follow-up report by identifies trends and analyzes data, reporting trends to the management.
• Providing communication and maintaining relationships with internal and external stakeholders, including payers.
• Working with team leaders, analyzes comprehensive data reports and spreadsheets to monitor denial trends to make recommendations.
• Participating in administration and supporting activities as a core member of the fiscal team.
• Managing the day-to-day billing operations with special emphasis on establishing systems/processes to assure that all information provided for billing is accurate and timely across all divisions and locations.
• Assisting in developing and communicating billing policies and procedures to ensure the timely filing of medical claims and to meet clean claim targets
• Conducting financial analysis to assess billing collection success and challenges and produces charts/tables/graphs to depict the results for delivery to various county stakeholders. Identifies areas to improve the revenue cycle in evaluating patient claims and medical billing functions.
• Managing insurance denial process and oversees the appeal process as appropriate to avoid delays. Ensures that the denial work is followed through by billing staff and to ensure claims processing occurs in a timely manner.
• Overseeing the entire pipeline of charge capture activities from encounter and review to correct coding and oversight to ensure accurate reimbursement for services billed. Requires experience working within an environment with an electronic health record.
• Directing process improvement initiatives related to front end revenue cycle functions, in collaboration with the clinical service leadership and senior executives of the agency.
• Creating and reviewing quarterly, monthly, and ad hoc reports that depict revenue outcomes, identify trends, and provide proactive communication.
• Delivering financial reports and regularly conducting complex financial analysis regarding trends to determine fiscal impact.
• Providing communication and maintaining relationship with stakeholders including payers.
• Collaborate with credentials and other departments. Provides direction and leadership in difficult situations.
• Coordinating responses to inquiries from internal auditors regarding billing and collection practices as well as revenue reconciliation.
• Supervising a diverse group of revenue cycle personnel to ensure staff are appropriately trained on compliant billing practices and procedures. Monitors, tracks, and evaluates staff productivity and performance.
• Monitoring workflow to assign priorities to ensure timely completion of reimbursement tasks as well as uniformity in documentation
• Assisting management in the process of IT HELP Desk ticket-report and takes actions for resolution.
• Evaluating billing requirements from clearinghouse vendor, implements changes, and disseminates relevant information
• Monitoring and documenting changes in payer manuals and guideline regularly, revised quarterly. Use tools that track and notify about payer manual updates. Utilizes tools that track and notify stakeholders about payer manuals and guideline updates regularly
• Providing direction to AAV in denial process by contacting insurance to resolve outstanding balances.
• Keeping abreast of current knowledge of changes in compliance standards, payer policies and state/federal regulations concerning coding, billing, and reimbursement processes
• Attends, actively participates in, and, at times, leads team meetings and huddles. Demonstrates leadership by providing training to new staff or deploying insurance updates to team members.

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MINIMUM QUALIFICATIONS::
Any combination of education, experience, and training equivalent to the following: (Click on the aforementioned link to learn how Fairfax County interprets equivalencies for "Any combination, experience, and training equivalent to")
Graduation from an accredited four-year college or university with either a bachelor's degree in accounting, business administration, public administration, public policy or related field; plus, three years of professional-level experience in finance, business administration, budgeting, or contract management, a master's degree in a related field or CPA may substitute for 1 year of experience.

NECESSARY SPECIAL REQUIREMENTS:
The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry check, and sanction screening to the satisfaction of the employer. A TB screening upon hire.

Certain positions with financial responsibility within this class may be subject to criminal background checks and/or credit checks as a condition of employment and periodically thereafter, as determined by the department head. An applicant or an employee may be required to submit a request for a criminal history record check and/or credit check to the appropriate agency; Applicants and employees within these positions must demonstrate financial responsibility in personal finances as a condition of employment.

PREFERRED QUALIFICATIONS:

• Master's degree in finance, business administration, health care administration or related field.
• Five or more years overseeing and managing large complex reports.
• Experience utilizing electronic health records.
• Experience with and highly proficient at financial systems, producing customized reports, and data manipulation to create management reports.
• Experience working with SAP or a similar automated accounting system.
• Five or more years of experience of mental health billing and follow-up.
• Five or more years of supervisor experience.
• Five or more years serving as revenue cycle manager for a behavioral health agency.
• Five or more years working in a managed care environment in the Commonwealth of Virginia.
• Five or more years' experience working within an electronic medical record system.
• Knowledge, skills, and abilities: Ability to develop and present complex financial reports and analysis, including detailed projections and financial scenarios relative to denial and forecasting and preparation and annual budget monitoring. Demonstrate initiative and knowledge to research, understand, and resolve complex payer denial issues. Strong written and oral communication skills, with an ability to prepare and present reports for decision-making. Demonstrated ability to work with limited supervision, set priorities, and multi-task. Extensive knowledge of the principles, methods, and practices of governmental financial management. Advance knowledge of Excel, Word, and PowerPoint.