Research Billing & Compliance Manager - EPIC billing experience needed!

Manager Of Research Billing Compliance

At Houston Methodist, the Manager Of Research Billing Compliance position is responsible for managing the development and execution of the Houston Methodist Research Institute research billing compliance program to meet all legal and institutional requirements. The position exists to drive a culture of compliance and all ethical standards in research billing to ensure that an environment appropriate to those needs is well established and maintained. The manager position responsibilities include managing the daily work activities of the work unit/department staff, ensuring quality, productivity, functional excellence and efficiency while assisting management in accomplishing strategic and operational objectives. In addition, this position provides guidance to staff and is responsible for staffing, budget compliance, contributing to staffing decisions such as hiring and terminating employment, coaching and counseling employees on work related performance, and assisting in the development and implementation of policies and procedures to ensure a safe and effective work environment. This position also implements training, monitoring and operations initiatives that secure compliance with ethical and legal business practices and accreditation/regulatory/government regulations.

Additional Information: Ideal applicants will have prior work experience with EPIC Billing.

Houston Methodist Standard

Patient Age Group(s) And Population(s) Served

Refer to departmental "Scope Of Service" and "Provision Of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

Houston Methodist Experience Expectations

• Provide personalized care and service by consistently demonstrating our I CARE values:
• Integrity: We are honest and ethical in all we say and do.
• Compassion: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
• Accountability: We hold ourselves accountable for all our actions.
• Respect: We treat every individual as a person of worth, dignity, and value.
• Excellence: We strive to be the best at what we do and a model for others to emulate.
• Practices the Caring And Serving Model
• Delivers personalized service using HM Service Standards
• Provides for exceptional patient/customer experiences by following our Standards Of Practice of always using positive language (AIDET, Managing Up, Key Words)
• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience
• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

People Essential Functions

• Performs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees in the department. Provides development and mentoring of staff. Meets or exceeds threshold goal for department turnover. Develops direct reports to perform these same functions.
• Provides fair and consistent leadership and communication to maintain a competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes. Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem.
• Facilitates and promotes effective team dynamics and teambuilding strategies within and between departments; participates and/or leads and facilitates department process improvements as needed.
• Meets or exceeds threshold goal for department and/or system metrics on employee engagement indicators.
• Facilitates/Leads a Clinical Research Billing Committee comprised of members from research, clinical and financial areas to support Clinical Research Billing Compliance.

Service Essential Functions

• Plans and organizes day-to-day department operations, schedule and activities. Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction.
• Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability. Serves and actively participates on various entity committees as a voice for the department.
• Develop and manage a training program for all individuals involved in the clinical research revenue cycle process, including research and non-research professionals.

Quality/Safety Essential Functions

• Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines, including infection control principles. Monitors and confirms staff maintain their required credentials that demonstrate competency per accrediting agency or department guidelines as applicable.
• Uses and optimizes information systems to enhance operations; supports entity-specific performance improvement and data management/analysis functions.
• Employs a proactive approach in the optimization of safe outcomes by monitoring and improving the department workflow, using peer-to-peer accountability, reporting accidents, near misses, and/or adverse events immediately per department protocol and identifying solutions via collaboration. Adopts lean principles in driving process improvements. Role models situational awareness, using teachable moments to improve safety.
• Monitors self and employee compliance with policies, procedures, and System HR Standards of Practice and performs associated actions upon non-compliance (i.e., focal point review requirements, disaster plan, inservices, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.).
• Responds to reported, suspected, or confirmed instances of research billing non-compliance. Participates in Compliance and other committees as required. Works collaboratively with the Internal Audit and Business Practices to respond to deficiencies and to strengthen research billing internal processes.
• Prepares policies and procedures associated with Clinical Research Billing Compliance.
• Provides oversight and performs detailed claims analysis and medical record review as necessary, including the following:
• Assessment of documents, e.g. policies and procedures, clinical trial protocols, study budgets, coverage analyses, etc.
• Performs detailed claims testing and medical review.
• Reviews Medicare Coverage Analysis to ensure completion prior to handing off to review by information technology teams

Finance Essential Functions

• Assists in the development of department budget and ensures that the department operates in a cost effective manner. Manages/audits department expenses within approved budget parameters, ensuring that the department meets the budgeted/flex revenue and/or expense targets on a monthly and annual basis. Develops staffing plans and schedules to meet department/patient needs that reflect understanding of the importance of cost-effectiveness.
• Implements department strategies to achieve financial target and staffing needs, developing others to do the same, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to department specifications.
• Prepares for and participates in research billing external audits and surveys. Oversees bill hold process in electronic medical record.
• Responsible for identifying process gaps and potential billing and coding inaccuracies and working with interdisciplinary teams to address these gaps.

Growth/Innovation Essential Functions

• Identifies and implements innovative solutions for practice or workflow changes to improve department operations or other department-specific measures by leading unit projects and/or other department/system directed/shared governance activities. Supports change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements or cultures.
• Proactively evaluates processes; recommends and implements action plan(s) for change; follows through to ensure effective, sustainable change. Participates in the development and implementation of new procedures and the review and revision of existing procedures.
• Identifies opportunities and takes action to build strategic relationships between one's area and other areas, teams, departments, and units to achieve business goals.
• Seeks opportunities to identify developmental needs of self and staff and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates My Development Plan (MDP) on an on-going basis. Conducts conversations with staff on their development.
• Manages the design, management, and completion of an array of research billing compliance audits that are designed to determine compliance with policies, procedures, laws, rules, and regulations. Utilizes the results of audits performed to drive a comprehensive educational program.
• Keeps current on regulatory developments and regulations, industry trends, and best practices.

Qualifications