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Stanford Health Care · 1 day ago

Sr. Manager - Professional Billing Organization (PBO) (Remote)

United States

Full-time

Remote

Senior Level

$66.52/hr - $88.14/hr

5+ years exp

Stanford Health Care is seeking a Senior Manager for their Professional Billing Organization (PBO) to provide organizational direction for timely billing and collection of physician charges. The role involves leading the department, driving performance improvements, and ensuring compliance with regulations while collaborating with various stakeholders to optimize revenue cycle processes.

Health CareHealth DiagnosticsHospitalMedicalPrimary and Urgent Care

Comp. & Benefits

H1B Sponsor Likely

Responsibilities

Provide leadership, direction and guidance; Set departmental goals and priorities and assign management oversight for the daily office operations

Monitor daily operating activity of department; conduct daily huddles with staff to review department performance and goals and make necessary adjustments in work assignments

Manage the performance and work products/services of staff

Direct managers in developing and implementing short- and long-term work assignments and objectives for staff. Develop guidelines for prioritizing work activities, evaluating effectiveness, and modifying activities as necessary

Review and drive improvements in Revenue Cycle ensuring financial obligations are met in accordance with SHC policies and procedures

Utilize feedback and needs assessment tools to understand internal customer expectations

Strive to provide service that exceed expectations and work to eliminate barriers to good service. Maintain relationships with all internal applicable parties, third party payers, and other agencies, as appropriate

Serve as a liaison to key department and clinic contacts to ensure that the PBO is meeting service levels and to address issues that may cause challenges to meet service levels and KPIs

Work collaboratively with clinic operations and other departments to drive organizational efficiencies and alignment and to ensure processes and systems are standardized and optimized for efficient and effective flow of accounts within the department and the organization

Maintain a complete record of current policies and procedures followed by staff in department; Responsible for maintaining complete knowledge of the revenue cycle and patient flow including steps taken by staff to complete these procedures; assists supervisors in understanding/implementing and adhering to department and organization policies and procedures

Identify areas of opportunity to apply process changes and/or technology implementation/updates to optimize PBO performance

Manage implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise; designing, develop, and monitor performance improvement processes (e.g. quality, accuracy, productivity and timeliness); identify continuous improvement opportunities and manage productivity metrics and efficiencies

Represent the department on various committees and attend administrative meetings committees as requested

Participate in professional development activities and maintain professional affiliations

Identify revenue cycle issues and provide leadership for root cause analysis and problem resolution

Maintain detailed understanding of all systems including electronic health record, physician billing systems and other business systems including system functionality, workflows, and reporting; proactively identify areas for improvement and engage with Information Technology and Revenue Cycle leadership to make necessary changes

Manage multiple projects in a timely and efficient manner

Conduct special projects and studies as directed; perform other related and incidental duties as needed or assigned

Ensure that functional areas of responsibility are staffed appropriately, assist in organizational changes and planning as necessary

Interview, select, hire and maintain competent and performing staff

Assure that management is adequately supported, trained and consistently meets competency requirements and levels Supervise, train, orient, coach, develop and evaluate performance over assigned personnel; initiate corrective actions to improve performance deliverables and/or resolve issues as they arise, recommend promotions or implement corrective/disciplinary actions as necessary

Foster a success-oriented, accountable environment

Participate in regular huddles throughout the PBO

Conduct regular unit staff meetings

Conduct and report on monthly productivity/quality assurance audits

Encourage ongoing staff development and growth. Develop individual staff goals and training plans

Ensure that personnel management is handled timely including evaluations, issue resolution, employee labor relations involvement and disciplinary action. Serve as escalation contact as appropriate

Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements

Keeps up-to-date on all regulatory and accrediting agency requirements, including Federal and State regulations and Joint Commission standards as they relate to billing, follow-up, remit posting and payment variance. Ensures compliance with policies and directives issued by Medicare, Medicaid, Third Party Payers, and others as needed

Maintains knowledge of and complies with established policies and procedures including government, insurance and third-party payor regulations

Assures compliance with the medical staff bylaws, rules and regulations, and hospital and departmental policies and procedures

Ensure adherence to all aspects of state, local, and federal Billing Compliance policies

Maintain and enforce patient / client / employee confidentiality

Provide overall direction and supervision to the billing, follow-up, collection, and resolution of all payor accounts; direct the day-to-day activities of insurance claim editing and billing, insurance follow-up, denial and appeals

Serve as a contact/resource to other departments and clinics for information on payor guidelines, policies and procedures; updates staff and outside departments on government (Medi-Cal/Medicaid/Medicare/VA) regulations and non-government payor medical and billing policies

Serve as escalation point to external stakeholders related to billing, follow-up, cash posting, payment variance and/or provider enrollment

Ensure that workflows are operating optimally to meet organizational KPIs and ensure timely reimbursement with minimal revenue leakage; monitor backlogs, identify root cause and implement corrective measures as necessary

Review current status of patient accounts to identify and resolve billing and processing problems in a timely manner

Set goals and implement measurement and tracking to ensure goals are met for delinquent AR, cash collections, denials and controllable write-offs

Solve difficult payment and associated payor problems (e.g. denials). Audit problem accounts

Monitor charge or payor patterns or trends in payment variance and communicate to external stakeholders as necessary

Provide regular updates to external stakeholders and Revenue Cycle leadership on payor variance and net revenue performance

Ensure that cash posting processes meet treasury and accounting practices and policies; support audit activities as necessary

Maintain working knowledge of the Epic payment posting system and perform ongoing training to staff as needed

Understand enrollment functions that support appropriate payer contracting and claims adjudication

Support physicians and clinics to ensure that all professional revenue can be billed and paid by payors

Work closely with Providers, Clinic Operations and Revenue Cycle leadership to address issues and problems related to provider enrollment (e.g. enrollment constraints); Proactively communicate Provider Enrollment issues to providers and impacted clinics

Qualification

Revenue Cycle ManagementAccounts Receivables ManagementCPTICD10 CodingEpic CertificationLeadership SkillsRegulatory KnowledgeCommunication SkillsProblem SolvingTeam LeadershipOrganizational Skills

Required

Bachelor's degree from an accredited college or university

Five (5) years of progressively responsible and directly related work experience

Excellent verbal and written communication skills, including effective reporting of operations, issues and performance

Excellent people skills, with an ability to partner with a dynamic leadership team and navigate enterprise politics and matrixed relationships

Demonstrated experience as a team leader; leading teams to generate a vision, establish direction and motivate members to achieve established goals

Skill in planning, organizing, delegating, and supervising

Skill in evaluating the effectiveness of existing methods and procedures

Skill in problem solving

Ability to manage in complex environment

Ability to develop long-range business plans and strategies

Ability to foster effective working relationships and build consensus

Ability to mediate and resolve complex problems and issues

Ability to provide leadership and influence others

Ability to recognize and analyze the impact of regulatory changes on the financial performance of professional revenue

Ability to read, interpret, and apply policies and procedures

Ability to set priorities among multiple requests

Ability to interact with patients, medical and administrative staff, and the public effectively

Knowledge of accounts receivables and reimbursement management

Knowledge of CPT, ICD10 coding and medical terminology

Knowledge of government program regulations and compliance requirements as they relate accounts receivable management

Knowledge of information system and software relating to accounts receivables management and billing; Knowledge with EMR and practice management systems

Knowledge of local, state and federal regulatory requirement related to the functional area

Knowledge of principles and practices of organization, administration, fiscal and personnel management

Company

Stanford Health Care

Glassdoor4.0

Stanford Health Care is a healthcare center that treats cancer, heart disease, brain disorders, and primary care issues.

Founded in 1885

Palo Alto, California, USA

10001+ employees

https://stanfordhealthcare.org

H1B Sponsorship

Stanford Health Care has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (102)

2024 (74)

2023 (82)

2022 (55)

2021 (54)

2020 (67)