HEALTH OPERATIONS MANAGER - SES - 50000237

Requisition No: 837677 

Agency: Veterans Affairs

Working Title: HEALTH OPERATIONS MANAGER - SES - 50000237

 Pay Plan: SES

Position Number: 50000237 

Salary:  $75,000.00-$83,000.00 

Posting Closing Date: 10/03/2024 

Total Compensation Estimator Tool

Requisition # 837677 

**ANTICIPATED VACANCY**

HEALTH OPERATIONS MANAGER - SES

FLORIDA DEPARTMENT OF VETERANS' AFFAIRS

Agency Headquarters, Mary Grizzle State Office Building

Largo, Pinellas County

Annual Base Salary Range: $75,000.00 - $83,000.00

Paid Bi-Weekly

Excellent retirement package and optional deferred compensation plan.  Health, vision, dental, disability, and other supplemental insurance available at reasonable premium rates.  Paid vacation and sick leave. Nine (9) paid holidays and personal day.  Tuition waiver available for State Universities and Community Colleges (up to 6 credits per semester).

Education and employment history must be verifiable.  Please attach any credentials you claim (degrees, certifications, etc.) to your application.

MINIMUM QUALIFICATIONS

• Three (3) years of experience in third party billing in a clinical related environment including Medicare, Medicaid, and Commercial Insurers
• Three (3) years knowledge of and experience using medical billing and Health Information software systems
• Knowledge and understanding of Federal and State regulations related to third party billing in a long-term healthcare environment
• Four (4) years of experience in a management or supervisory role
• Proficient in Microsoft Excel/Office and internet
• Verbal and written proficiency in the English language
• The ability to communicate clearly and effectively convey ideas, both verbally and in writing
• Must have the ability to work on multiple, complex projects and the ability to solve problems effectively and develop workable solutions
• The ability to work well in a team environment, leading with honesty, integrity, and empathy
• Successful completion of the due diligence process, to include but not limited to, a Level II background check.

PREFERRED QUALIFICATIONS

Preference will be given to candidates with the following qualifications:

• Three (3) years of experience in third party billing in a long-term healthcare environment including Medicare, Medicaid, and Commercial Insurers and related accounting operations.
• Experience in providing technical assistance and support to long term care billing professionals
• An understanding of the concepts of Quality Assurance and Performance Improvement
• The ability to work cooperatively with other departments and divisions in order to achieve Agency mission

POSITION DESCRIPTION

This position is an independent managerial work planning, supervising, directing and monitoring the operations of the Third-Party healthcare Billing Unit of the Florida Department of Veterans’ Affairs. The incumbent ensures compliance with State and Federal laws and regulations as it relates to the timely and accurate submission of claims for services provided in State Veterans’ Homes.  The incumbent exercises independent judgement in formulating or assists in the formulation of policies and procedures which have a significant impact on day-to-day operations.  The incumbent ensures the coordination and effectiveness of administrative, program, and operational aspects of service delivery, providing liaison and consultative capabilities for the solution of operational and management problems.  Responsible for the ongoing review of existing Standard Operating Procedures and Policies as well as the development of new policies and procedures which enhance efficiencies and effectiveness based upon internal or external changes to the healthcare environment and/or operational goals. Collaborates with Homes Division personnel to provide information, support, and recommendations for changes to policies and procedures which may increase collections and/or create efficiencies to existing practices.  This position will maintain a strong working knowledge of the healthcare industry including policy or procedural changes, trends, and potential opportunities to provide additional services or enhance the services provided by the Agency This is an independent professional position that reports to the Director of Administration.  Responsibilities include but are not limited to, maintenance of the residents’ billing data maintained in the health information system, timely and accurate billing and collection of claims for long term care services, monitoring of accounts receivables to ensure aging of claims meets the collection objectives, submission of reports to internal and external stakeholders, and others. This position also monitors third party accounts receivables and collections, Resident Trust Fund reconciliation/practices, private pay debt collection activities and compliance, and the timely submission of required reports to the Department of Financial Services and various other Governmental Agencies.  Partners and collaborates with the other divisions/bureaus of the Agency, working toward the accomplishment of the goals and mission.

General Supervisory Responsibilities

Supervises the Business Manager III who is responsible for the timely and accurate submission of third-party claims to all payers, the Professional Accountant responsible for monitoring private collections, account adjustments, Resident Trust Fund oversight, and the Senior Management Analyst responsible for oversight and monitoring VA/Hospice accounts, Annual Financial reviews, Occupancy Reports, the annual Cost of Care calculations, and a variety of Revenue tracking reports, among others.  Assigns personnel to various projects, providing written guidance when necessary, provides comprehensive supervision for direct reports and provides input on job performance on indirect reports, performs audits and reviews to ensure adherence to existing policies and procedures, ensures appropriate levels of training necessary to perform all work functions, and monitors performance to ensure compliance with all applicable laws, regulations, guidelines, and policies.   Consistently provides beneficial feedback to Billing Unit staff and, at a minimum, provides a written quarterly and annual performance review of each direct reports’ job performance.  Ensures that all employees working in the Billing Unit understand and work toward established goals, effectively collaborating with management and each other to improve overall Unit performance.  Ensures each Billing Unit staff member receives adequate initial and ongoing training to meet professional standards.

Administration and monitoring of Third-Party Billing Activities

• Monitor the use and performance of the Health Information Systems used by the Billing Team to ensure proper performance and full use of available features.
• Provides direction and oversight of the Billing Unit’s Quality Assurance and Performance improvement program including data collection, analysis, and collaboration on resolutions to identified issues.
• Monitor the processing and justification for all adjustments to payer accounts, reviews all Third-Party Refunds, and Private refunds >= $1,000.00 and the submission of uncollectible accounts to the Department of Financial Services.
• Monitors the timely submission of clean claims to all Third-Party payers.
• Monitors and provides direction to staff on the prompt adjudication of denied or underpaid claims through the process of Accounts Receivables Review on a minimum monthly basis.
• Monitors the timely communication with Homes Business Office Managers and other relevant Homes Staff regarding pre-billing verifications and post payment issues.
• Monitors private pay collection activities and ensures compliance with S.S. 17.20. Submits write-off requests to Department of Financial Services.
• Prepares annual Claims for Collection Report to be submitted to Department of Financial Services.
• Prepares annual request for exemption to the Chief Financial Officer for assignment of accounts to collection agency for the agency.
• Provides routine monitoring of payment posting processes.
• Responsible for the accurate quarterly and annual reporting of Bad Debt to be included on Cost Reports.
• Prepares annual PS&R/Resident Mix reports annually for Cost Reporting purposes.
• Ensures timely and accurate responses to all internal and external auditors.
• Completes a Quarterly Report for Director of Administration which provides a summary of Aging Accounts status, summaries of common or developing claims/collection issues for all payers, a listing and commentary regarding quarterly achievements, any current/ongoing improvement projects, and reporting of existing obstacles and/or opportunities.
• Routinely consults with Billing Office staff regarding trending issues and problems to solicit input into effective resolutions.
• Routinely advises the Director of Administration on issues which may negatively impact billing, collections, or the overall operations and function of the Billing Unit.

Language

English proficiency.

Knowledge

• Knowledge of supervisory and management principles and best practices in the field of Long-Term Care business administration
• Knowledge of instructional methods and training techniques including individual development plans
• Knowledge of Medicare, Medicaid, Managed Care, and Commercial third-party billing. 
• Knowledge of the principles and techniques of effective verbal and written communication. 
• Knowledge of State of Florida and Federal rules and regulations governing Long Term Care and Medical billing.

Skills

• Applicant must have excellent supervisory and leadership skills. 
• Excellent communication skills; both written and verbal. 
• Excellent interpersonal and customer service skills. 
• Moderate to high level of computer skills (Internet searches, Excel, Word, etc.). 
• Must be initiative-taking and work well in a team environment. 
• Applicant must have strong organizational skills.

Abilities

• Applicant should possess the ability to multi-task, manage short deadlines, be detail oriented & flexible, and possess the ability to maintain effective working relationships at all levels.
• Applicant must possess the ability to communicate effectively verbally and in writing ensuring that information is received and understood.  
• Applicant must have the ability to delegate effectively, train staff, make decisions based upon analytical data, and organize thoughts and positions in a clear and concise manner; supervise others, plan, organize and coordinate work assignments.
• Applicant should be able to use Quality Assurance and Performance Improvement techniques to collect and analyze data to identify, report, and correct trends.
• Applicant must possess the ability to understand and apply applicable rules, regulations, policies, and procedures. 

This position is in the Select Exempt Service

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.