As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
Under the direction of the CBO Revenue Cycle Applications Manager/Practice Reimbursement Manager, this position will provide overall leadership in planning, organizing and directing revenue cycle activities for the CBO Revenue Cycle Applications Analyst Team. This position will lead, supervise, develop and train associates performing the tasks of editing and transmitting electronic and paper claim submissions. This position is responsible for providing direct support to the Central Business Office (CBO) and other Nemours affiliates by ensuring all professional and hospital electronic and paper claims are transmitted correctly and timely to the responsible parties for prompt adjudication and payment. As part of the Revenue Cycle Applications Team, any and all possible edits, errors and/or rejections from claims processing or issues surfaced by the CBO, are reviewed and delegated to the Revenue Cycle Applications team for possible corrective action. Scope of work includes, but is not limited to, maintaining, updating and correcting the PB/HB Claims and Remittance setup within the Epic Hyperspace and Resolute Text applications, testing and validating all system build and new release functionality, maintaining the electronic and paper claim submission forms and all related items that pertain to claims generation and production and denial management. This position is also responsible for ensuring other Resolute Master Files are set up to correctly support claims, remittance, claims status and other stages of the Revenue Cycle. Works with CBO representatives, leadership and other internal departments to perform reviews and analyses of workflows, data collection, report details and other technical issues associated with Epic Resolute Claims and Remittance applications.
The CBO Revenue Cycle Applications Supervisor should have the ability to recognize opportunities for process improvement and optimization activities designed to create more knowledgeable end users. The role of this position includes acting as a change agent, educator and resource in advancing the strategic mission of Nemours.
Lead, supervise, develop and train the CBO Revenue Cycle Applications team. Staffing responsibilities for the CBO Revenue Cycle Applications team.
Perform productivity and quality audits of direct reports as it relates to Performance Management goals. Perform annual performance reviews.
Facilitate weekly and monthly team meetings.
Coach and counsel associates in compliance with Nemours policies and procedures.
Establish collaborative relationships with other departments/clinics/providers as necessary for effective revenue cycle performance and results.
Identify and report opportunities to enhance the revenue cycle to improve cash flow, reduce days in accounts receivable, minimizes write offs and decrease denials.
Work with clearinghouse and other partners to ensure accurate claims transmission from the clinics and hospitals through appropriate portals and into the payer’s system.
Serve as project manager for Epic related projects and upgrades as well as any assigned Nemours projects and initiatives.
Delegate project tasks and assignments to analysts, as needed.
Work closely with Epic Technical Support on resolution of surfaced Epic software related issues as it pertains to claims and remittance.
Able to perform all job functions expected of CBO Revenue Cycle Applications Analysts.
QUALIFICATIONS AND SKILLS:
Associate's Degree in Business or Health Care Administration. Bachelor's Degree preferred. Equivalent on the job experience may substitute for degree.
Certification in both Epic Resolute PB and HB Claims Administration are required.
1-3 years of job related leadership experience at a supervisor level preferred.
Excellent written and verbal communication and presentation skills for leadership, technical and business audiences.
Ability to lead effectively and interact with a wide variety of levels of people in a variety of settings.
Excellent customer service (internal and external) with the ability to work well under pressure and deadlines.
Strong organizational skills with a track record of formalizing and improving new departmental processes and procedures.
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.