This position is responsible for all aspects of the CCMC Denial, Payment Review and Transplant team operations.

Facilitate and coordinate the daily operation of the CCMC Denial, Payment Review and Transplant units/teams.

• Monitor follow-up worklists. 
  • Develop and maintain an action plan to ensure that billing WIP goals and follow-up WIP goals are met by the end of each week. 
• Act with delegated authority as a liaison between Director and staff. 
  • Expedite assistance for staff with questions or issues and promote revenue collection/resolution.
• Analyze workflow and implement process improvement solutions when necessary.
• Provide leadership within the Denial, Payment Review and Transplant team and actively participate in other roles within the department.
• Develop detailed knowledge of government programs, regulations, and reimbursement methodologies.
• Represent Director and PBS to outside payers, agencies, and OHSU departments.
• Review all accounts on Denial, Payment review and Transplant high dollar reports to determine if assistance is needed to ensure prompt resolution; coordinate with staff as necessary to expedite payment.
• Monitor monthly aging reports and Epic WQ’s to ensure timely resolution of payments.
• Perform team account reviews to ensure quality follow-up and collection of accounts.
• Work with teams to update and maintain procedures and compile training manuals.
• Monitor bulletins released by CMS/Medicare and websites/newsletters released by payors for updates and disseminate program information to team members and other OHSU departments as appropriate.
• Perform random remittance advice reviews to identify patterns; research and implement corrections/changes as needed, ensure regulatory compliance, and work with third parties as needed to maximize revenue collection.
• Ensure guidelines are implemented, enforced and updated as appropriate.
• Assist with the implementation of regulatory changes. 
  • Work with PBS staff, other OHSU departments and third parties as necessary.
• Assist with coordinating responses to for some CCMC audits as appropriate (outside of line level audits.).
  • Maintain files for retention.
• Support Manager/Director as needed in working with OHSU’s Office of Integrity and/or legal department.
• Perform internet research of  third party payors regulations and provider rules to provide OHSU departments with requested information.
• Timekeeping.
  • Perform bi-weekly timekeeping reviews to correct errors before each payroll run. 
  • Prepare and maintain team vacation calendar.
  • Keep attendance spreadsheets accurate and current in accordance with the PBS Attendance Policy. 
  • Maintain confidentiality.
  • Review and authorize vacation schedules and reallocate work as appropriate.
• Attend Aeos Metric Meetings monthly meetings and weekly Management Team meetings.
  • Update team following meetings.
• Review the Huron Weekly Report Set by end of day Monday to ensure accuracy and completeness.
• Attend meetings as requested, schedule team meetings, and prepare agendas for meetings.
• Other duties as assigned within the scope of the established class specifications; includes team support and environmental activities.

• 3 years of recent medical collection and/or billing experience. Work experience must have occurred within 5 years of hire date.  
• Experience in hospital billing and/or UB-04 claims.  
• Knowledge of and experience in interpreting managed care contracts.  
• CRCS certification required.  

• Four years of general office or secretarial experience; OR
• An Associate’s degree or certificate in office occupations or office technology and two years of general office or secretarial experience; OR
• A Bachelor’s degree and two years of general office or secretarial experience; OR
• An equivalent combination of training and experience.
• Familiarity with Epic applications.
• Experience working with a variety of reimbursement methodologies.
• Knowledge and experience with APC’s.
• Ability to use online coding applications.
• Experience with the Medicare program within last 3 years.
• Demonstrated leadership abilities in a team environment.
• Extreme confidentiality required.
• Ability to work and perform in a high volume environment.
• Proficient in Microsoft Office Suite applications in Windows environment.
• Internet research experience.
• Familiarity with DRG, CPT, HCPCS and ICD-10 coding, familiar with modifiers and their use.
• Ability to interpret regulations, policies, laws, rules, contracts, etc.
• Detail oriented, analytical with strong written and oral communication skills.
• Flexibility required due to frequently changing regulations.
• Ability to work independently with minimal supervision.
• Ability to use multiple system applications.
• EPIC certification in HB Resolute.

Benefits 

• Healthcare for full-time employees covered 100% and 88% for dependents.
• $50K of term life insurance provided at no cost to the employee.
• Two separate above market pension plans to choose from.
• Vacation - up to 200 hours per year dependent on length of service.
• Sick Leave - up to 96 hours per year.
• 9 paid holidays per year.
• Substantial Tri-Met and C-Tran discounts.
• Employee Assistance Program.
• Childcare service discounts.
• Tuition reimbursement.
• Employee discounts to local and national businesses.

We are Oregon's only public academic health center.

In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.

All are welcome.

OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply.

To request reasonable accommodation, contact askhr@ohsu.edu