Manager, Professional Billing and Claims

Community-Care-Cooperative; Boston (MA); On-site; USD 103,000 - 130,000; Full time

Job summary

Community Care Cooperative (C3) in Boston, MA seeks a Manager of Professional Billing and Claims to oversee Epic applications for billing and SBO across our health center network. The role reports to the Senior Director of Applications and drives workflow design, testing, and coordination with Epic representatives and end users.

Ideal candidates bring 5+ years of Epic experience in professional billing, SBO, or claims, with SBO certification and strong understanding of the complete revenue cycle

Qualifications

• 5+ years Epic experience in professional billing, SBO or claims
• Certification in Professional Billing with SBO
• Knowledge of the overall revenue cycle from front to back
• Knowledge of financial reporting and Epic go-lives

Responsibilities

• Lead Epic workflow design, development, testing and optimization
• Coordinate with Epic representatives and health centers to meet business needs
• Maintain scope, schedule and quality of Epics for billing/claims
• Manage upgrades, contracts, and third-party integrations
• Partner with project managers to ensure successful implementations

Skills

Epic experience

SBO certification

Revenue cycle knowledge

Financial reporting

Epic implementations

EMR optimization

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Manager, Professional Billing and Claims

Full Time Boston, MA, US

17 days ago Requisition ID: 1147

Salary Range: $102,561.00 To $130,000.00 Annually

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

Community Technology Cooperative (CTC), a subsidiary organization of C3 is seeking a highly motivated Manager to lead our Epic systems application teams for professional billing and claims applications for our existing customers and upcoming implementations. The Manager of Professional Billing and Claims will be housed under a subsidiary organization of C3, Community Technology Cooperative, LLC (CTC) and reports to the Senior Director of Applications. The Epic applications for the Manager role include Epic’s Professional Billing, Claims, Benefits Engine, Reimbursement Contracts and SBO (Single Billing Office) applications in addition to third-party applications. The Manager monitors and advises on various aspects of their respective applications including internal collaboration with colleagues as well as external stakeholders.

Responsibilities

• Workflow development, design, and testing for Epic applications
• Guide workflow design, building, and testing the system, and analyzing other technical issues associated with Epic software
• Partner with Epic representatives, the health centers’ business community, and end users to ensure the system meets their business needs regarding the project deliverables and timeline
• Engage with appropriate leadership regularly to review the status of projects and issues
• Problem-solve concerns and elevate issues to appropriate members of the leadership team
• Work collaboratively with the leadership team of CTC and C3 towards the strategic goals of C3, CTC and the health centers that we serve
• Develop an understanding of operational needs to collaborate and set the direction for the organization's workflows
• Assist with the identification, evaluation, and assessment of new technology, developing recommendations on the impact of integration with existing workflows and systems
• Ability to manage and prioritize initiatives with competing priorities
• Demonstrate a proactive mindset with the ability to analyze and anticipate possible events prior
• Answer questions and foster enthusiasm for HIT projects within the health centers
• Maintain the scope, schedule, and quality of the project in their specific application areas and/or team
• Set clear expectations for team members, including defining what they should do at each phase of the project
• Work closely with the program manager and other project managers to coordinate activities
• Ensure that the health center community is informed and engaged with all aspects of the implementations and workflow
• Advise and coach team members by providing guidance on project issues, key success factors of the project, and lessons learned
• Develop and mentor team to build a culture of excellence, collaboration and great customer service
• Identify and document implementation issues and best practices to create a process for future implementations
• Share the positive effects of innovation and system capabilities with team members
• Reinforce the importance of the project together with the executives and the project manager, and providing consistent communication to the project team
• Appropriately matching team member skills to team responsibilities
• Manage the project from an organizational perspective while attending to detailed tasks
• Work directly with third-party vendor contacts for escalations and participating in monthly or quarterly check-ins
• Maintain contracts with third party vendors, including but not limited to monitoring volumes for overage costs, reporting of total visits and users for annual renewals
• Manage upgrades, maintenance and implementation of new features for third-party vendors
• Other duties as assigned

Required Skills:

• 5+ years Epic experience in the areas of professional billing, SBO and/or claims applications in an Epic IT department
• Certification in Professional Billing with Single Business Office (SBO)
• Knowledge of the overall revenue cycle from the front end to back-end billing
• Knowledge of financial reporting
• Experience tracking financial metrics and revenue cycle activities for Epic go lives
• Ability to provide direction and oversight for simultaneous core organization projects
• Experience with a minimum of two Epic implementations required
• Proven record of accomplishment of EMR implementation and optimization of systems

Desired Other Skills:

• Prior experience with FQHCs is strongly preferred
• Familiarity with the MassHealth ACO programs
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:

** In compliance with Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **