Bon Secours Mercy Health

Financial Planning and Analysis

• The Financial Navigator is responsible for comprehensive patient financial management.
• Conducts patient financial navigation and patient fiscal need assessments.
• Works closely with providers, patients, hospital staff, and practice administration to determine and execute appropriate fiscal solutions.
• Provides analytical and operational support for facility administration and financial related activities including drug recovery, billing and payment processes, and evaluation of financial performance.
• Conducts financial counseling for infusion patients prior to initial treatment and manages copay assistance.
• Develops and maintains a close interface with drug recovery and copay assistance processes including patients, hospital departments, and drug manufacturers.
• Maintains patient assistance database and coordinates procuring free drugs for accounts with medical necessity denials.
• Prepares evaluations of hospital, facility, or pharmacy related concerns and proposals to quantify financial implications.

Financial Navigator – Ambulatory Pharmacy

Manager

• The RN Care Manager is responsible for providing coordination of care for patients to support safe, seamless, timely transitions across the continuum.
• Utilizes a collaborative process, the RN Care Manager identifies (using quantitative and qualitative methods), assesses, plans, implements and evaluates the options and services required to meet an individual’s health and health-related needs, including social determinants that affect one’s overall wellbeing.
• Responsible for screening, identification, and assessment of individuals in need of active Case Management services and promotes the right resources, at the right time and at the right place.
• Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors.
• Plans with the patient, caregivers and members of the healthcare team to maximize health care responses, quality and cost-effective outcomes.
• Monitors and revises the plan as indicated when patient condition changes.
• Completes all necessary documentation.

Registered Nurse, Care Manager – PRN

Accounts Receivable

• Examine denied and underpaid claims to determine reason for discrepancies
• Communicate directly with payers to follow up on outstanding claims, file appeals, resolve payment variances, and ensure timely reimbursement
• Maintain a thorough understanding of federal and state regulations, as well as payer specific requirements
• Document activity accurately including contact names, addresses, phone numbers, and other pertinent information
• Answer all incoming phone calls to the business line accepting payments, answering billing questions, assist patients with financial assistance
• Process patients statements monthly per policy
• Reviews all credit balances and processes as required by Medicare, Medicaid and all Third Party Payors

Accounts Receivable Specialist

Account Manager

• The Senior Associate Relations Manager is responsible for leading a team of Associate Relations Managers supporting various markets.
• Coach team members on associate relations skills and focus on development of team members' subject matter expertise.
• Resolve issues at the lowest level possible.
• Work directly with various leadership levels from front line leaders to higher level leadership up to executives.
• Guide and support leadership in complex and high-risk associate relations decision making.
• Handle a case load and effectively manage the review, resolution and documentation of code of conduct related matters and policy violations.
• Lead a team of Associate Relations Managers who manage the documentation of code of conduct related matters and policy violations.
• Support and guide Associate Relations Manager in handling employment concerns, providing quality customer service.
• Provide strategic Associate Relations support, business partnership, and coaching to all levels of the ministry.
• Demonstrate a change management mindset through process and policy improvement to enhance employee experience.

Senior Associate Relations Manager

Auditor

• Conducts independent compliance investigative audits requested by Legal or Leadership and as part of the Compliance due diligence during merger and acquisition activity
• Assists in the preparation of audit reports for presentation to Legal or Leadership and presents findings and proposed action plans
• Performs investigative audits and assists with response and development of corrective action plans stemming from governmental reviews and inquiries
• Performs annual compliance workplan provider revenue cycle audits and projects related to the European Group
• Assists in the quality review of Bon Secours Mercy Health coding, billing, and claims processing to ensure compliance with policies
• Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation
• Demonstrates advanced industry and audit knowledge and is recognized as a subject matter resource for the team and the ministry
• Performs research, creates presentations, and otherwise supports the Revenue Cycle Compliance team with developing written reports, educational materials, and trending dashboards
• Utilizes data analytics and extraction for developing trends, metrics and dashboards related to external audit activity of governmental agencies, denials, or regulatory changes
• Conducts and assists with routine provider revenue cycle monitoring initiatives established from data analytics
• Acts as a Superuser for audit and compliance applications and platforms
• Develops standard operating procedures (SOPs) and process workflows to ensure standardization across the ministry
• Responsible for training new staff on audit processes, systems, coding guidelines (to include annual and periodic coding changes), and regulatory changes impacting revenue cycle
• Provides guidance and serves as resource to auditing staff regarding SOPs, coding questions, audit findings, and audit report development
• Ensures that Revenue Cycle Compliance leadership is apprised of local, remote and emerging issues, adverse outcomes or deficiencies that could impact Bon Secours Mercy Health's public status
• Maintains awareness of fraud, waste, and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking
• Displays a commitment to excellence, accuracy, and thoroughness in all activities and searches for way to improve and promote quality

Senior Compliance Auditor

• Oversees and directs staff, formulating and implementing patient care policies and standards of care for patients
• Prepares Commission on Cancer Accreditation (CoC) American College of Radiology (ACR) surveys
• Plans, implements, and evaluates designated oncology services and administrative operations
• Oversees budgetary parameters and daily productivity metrics
• Establishes and maintains patient care protocols and standards, ensuring compliance with federal and state regulations
• Develops and implements quality improvement, safety, and patient care programs
• Supervises and evaluates clinical staff
• Participates in policy development, long-term planning, and project implementation

Cancer Center Manager – Oncology

Medical Billing and Coding

• Trauma Registry must provide timely data entry of all trauma patients admitted to or transferred.
• Must meet all requirements of the Ohio State Trauma Registry and the Northwest Ohio Regional Trauma Registry.
• Facilitate reports according to predetermined specifications.
• Develop strong relationships with patient care providers, physicians and community resources.
• Utilize data entry programs effectively and coordinate data within various data systems.

Trauma Registrar Coding Specialist

• In collaboration with Market President, responsible for incremental improvement of in-network utilization through growth in new patient referrals across the BSMH Product Portfolio.
• Uses data to make informed decisions that guide a strategic call plan that delivers high impact face-to-face visits each month.
• Conducts face to face visits with physicians, providers, and influencers to inform them of new services and/or changes in care delivery to optimize care coordination of in-network offerings for empaneled patients.
• Identifies barriers and facilitates resolution improving care delivery, often resulting in substantial process change and/or new service offerings.
• Convenes market stakeholders to discuss and address competitive threats, performance improvement opportunities, and product differentiators to enable incremental growth.

Physician, Provider Relationship Manager

Director

• Leads strategy development and overall implementation of information and knowledge critical to meeting the system's strategic goals and initiatives.
• Ensures the validity and replicability of data analytics and sources.
• Provides support to Marketing on the development of consumer primary and secondary research.
• Recommends and implements strategies and methodologies to strengthen strategic planning and business development analytic methods and solutions.
• Identifies and utilizes internal and external resources to reproduce, evaluate, research, and improve techniques.
• Develops measurement and evaluative tools for system, especially in area of Service Lines, Physician Provider Relations, Ambulatory Services, Consumer Insights and Business Development.
• Manages assigned staff and serve as a convenor of strategy analyst for training, professional development, and best practice sharing.
• Provides consultation to System and Strategy executive leadership.

System Director – Strategic Analytics

• Provide care to patients discharged to post-acute facilities and maintain a caseload according to productivity standards
• Perform and coordinate work with the patient, family or support members, inpatient case management team, and interdisciplinary care team members
• Communicate regularly on post-acute care of specific patients, as well as population level care and performance
• Run daily reports for transitions of care, make assignments, and review goals of care
• Communicate at minimum weekly with skilled nursing facilities to encourage progression of care within an appropriate length of stay
• Evaluate effectiveness of care plan with Interdisciplinary Team (IDT)
• Conduct comprehensive assessments and complete required documentation
• Perform patient outreach according to established protocols and document in electronic medical record
• Coordinate referrals and transitions of care from one provider to another or from one care setting to another
• Provide Patient and Family or Caregiver education
• Refer to appropriate next level of care and discharge planning with facility, patient, and family or caregiver
• Conduct monthly meetings with high volume facilities on overall performance, quality, and readmissions