Southeast Medical Group

Description The RCM Patient Billing Liaison is responsible for managing and resolving all patient billing-related inquiries received via email and Smartsheet submissions from clinic managers. This role serves as a key liaison between patients, practice managers, and the Revenue Cycle Management (RCM) team to ensure timely, accurate, and professional resolution of billing concerns. The Liaison is expected to resolve inquiries within a 48-hour turnaround time while maintaining detailed documentation and clear communication across all stakeholders. Requirements Key Responsibilities: - Manage and respond to all patient billing inquiries received through email and Smartsheet platforms. - Collaborate with the full RCM team to investigate and resolve billing concerns within a 48-hour timeframe. - Document all account activity, updates, and resolutions thoroughly and accurately. - Communicate directly with patients and/or practice managers as needed to resolve issues or provide updates. - Support front-end, back-end, and Patient AR call center teams with outbound patient communication via phone, email, and other channels. - Assist with soft collections efforts, ensuring a professional and patient-centered approach. - Identify, track, and analyze billing inquiry trends; prepare and report findings to leadership. - Work closely with Operations and Revenue teams to ensure alignment and continuous process improvement. - Perform other duties as assigned. Qualifications & Requirements: - Minimum of 3 years of experience in revenue cycle management, including denials management and working with all payer types. - Minimum of 3 years of call center experience, including collections. - Minimum of 2 years of coding experience preferred, not required. - Strong knowledge and hands-on experience with Allscripts and eClinicalWorks (eCW) required. - Advanced proficiency in Microsoft Office Suite (Excel, Outlook, Word, etc.). - Excellent multitasking, organizational, and time management skills. - Strong written and verbal communication skills with a high level of professionalism. - Ability to work collaboratively in a fast-paced environment while meeting strict deadlines. Core Competencies: - Attention to Detail & Quality Assurance – Ensures accuracy, consistency, and high standards in all work outputs. - Problem Solving & Critical Thinking – Analyzes issues effectively and implements practical, well-informed solutions. - Client-Centric Service & Relationship Management – Delivers responsive, high-quality service while building and maintaining positive relationships. - Accountability & Results Orientation – Takes ownership of responsibilities and consistently meets commitments and performance expectations. - Communication, Collaboration & Teamwork – Communicates clearly, works effectively with others, and contributes to a positive team environment. Work Environment: This role operates within a collaborative RCM environment, supporting multiple departments and requiring frequent interaction with internal teams and external patients. Performance Expectations: - Meet or exceed 48-hour resolution turnaround time for all assigned inquiries. - Maintain accurate and complete documentation for all accounts handled. - Demonstrate consistent professionalism in all patient and internal communications. - Provide regular reporting on trends and contribute to process improvement initiatives.

Description Position Title: Manager, Utilization Management (UM) Company: Southeast Primary Care Partners – Physicians First ACO (PFACO)/Physicians First Health Network (PFHN) Location: Primarily Remote | Occasional Travel Required Position Overview Physicians First ACO (PFACO) and Physicians First Heatlh Network (PFHN), divisions of Southeast Primary Care Partners, is seeking an analytical and proactive Manager, Utilization Management (UM) to monitor, evaluate, and optimize healthcare utilization across a network of independent provider practices. This role is central to improving total cost of care and patient outcomes in a value-based care environment. The UM Manager will work closely with our Analytics Team to leverage claims data, population health reports, and EMR data. The UM Manager’s goals are to identify utilization trends, uncover drivers of high spend, and implement actionable strategies in collaboration with clinicians, patients, and senior leadership. The role involves conducting reviews for medical necessity and the utilization of ancillary services to ensure the appropriate level of patient care. The Manager determines the appropriate level of patient care through collaboration with physicians, reviews, monitors, evaluates, and coordinates patient stays to assure services are timely and efficient, maintains appropriate documentation, and ensures compliance with federal, state, and local requirements, as well as organizational policies and procedures. The ideal candidate brings strong utilization management experience (in payer, provider, or hospital settings), thrives in a data-driven environment, and is comfortable working independently while influencing provider behavior. Requirements Key Responsibilities Utilization Analysis & Monitoring - Analyze daily claims, population health data, and EMR data to identify utilization trends and cost drivers, incorporating industry best practices such as predictive analytics and risk stratification models (e.g., aligned with CMS ACO benchmarks). - Monitor key metrics, including Emergency Department (ED) utilization; admission and readmission rates; potentially avoidable admissions; post-discharge follow-up gaps (7–14 days); Skilled Nursing Facility (SNF) utilization and bounce-backs; hospice utilization patterns (including prolonged stays); high-cost imaging, procedures, and specialist utilization; and identify variation in utilization patterns across practices and providers. Develop a UM Team - Develop and lead a strong UM team to support multiple payers, ACOs, and physician practices, fostering interdisciplinary collaboration and ongoing training in evidence-based utilization review protocols (e.g., per URAC or NCQA standards). Practice & Clinician Engagement - Identify physician practices’ patients with high utilization and spend. - Conduct targeted outreach to share actionable, data-driven insights; highlight opportunities to reduce unnecessary utilization; and support workflow improvements and care coordination, drawing on best practices like shared decision-making tools and provider education sessions. - Deliver clear, practical recommendations tailored to each practice. Patient-Level Intervention - Identify high-risk, high-cost patients using claims and analytics tools. - Collaborate with practices on care management strategies, incorporating best practices such as patient-centered care plans and motivational interviewing techniques. - Conduct patient outreach (as appropriate) to reinforce care plans; promote appropriate site-of-care utilization (e.g., ED avoidance); and address gaps in follow-up care. Clinical Collaboration - Partner closely with the Medical Director to review complex cases and utilization patterns; align on clinical appropriateness and interventions; develop strategies to reduce avoidable utilization; and escalate cases requiring clinical review or physician input, ensuring adherence to evidence-based guidelines (e.g., from AHRQ). Systems Navigation & Workflow - Navigate multiple EHR systems across independent practices. - Extract and interpret clinical and operational data to support initiatives, while maintaining HIPAA compliance and data security best practices. - Utilize population health and analytics platforms to guide daily workflow, optimizing for efficiency and Triple Aim outcomes. Performance Improvement & Reporting - Track and report on utilization trends, interventions, and outcomes. - Support development of dashboards and performance reports, incorporating continuous quality improvement methodologies (e.g., Plan-Do-Study-Act cycles). - Contribute to ACO-wide strategies to reduce costs and improve quality, ensuring compliance with OSHA standards for safe remote and on-site work environments and FLSA regulations for fair compensation and overtime. Qualifications Required - 3–5+ years of experience in Utilization Management, Care Management, or a related field. - Bachelor’s degree in Nursing, Healthcare Administration, Public Health, or a related field. - Clinical background (currently licensed LPN, RN, or equivalent). - Experience in payer, hospital/health system, or ACO environment preferred. - Strong understanding of healthcare utilization drivers; claims data analysis; transitions of care; and care coordination. Preferred - Certification (e.g., CCM, CPUR, or equivalent) is a plus. - Experience in value-based care models (ACO, Medicare Advantage, Commercial) highly desirable. Core Competencies - Strong analytical skills with the ability to translate data into actionable insights. - Excellent communication skills with the ability to engage and influence providers. - Ability to work independently and manage priorities effectively. - Comfortable navigating multiple systems and adapting to varied workflows. - High level of professionalism and discretion. Work Environment - Primarily remote role with occasional travel to physician practices (travel may include adherence to OSHA safety protocols for on-site visits). - Independent position with a high level of autonomy, requiring self-motivation in a virtual setting. - OSHA Compliance Requirements: As a hybrid remote position with occasional travel to physician practices, ensure adherence to OSHA standards primarily during on-site visits. This includes proper ergonomics for any prolonged standing, safe lifting techniques (e.g., lifting up to 50 lbs),. For remote work, focus on ergonomic setup of home office to comply with OSHA guidelines for virtual environments. Why Join PFACO? - Play a key role in driving value-based care transformation. - Work directly with leadership to impact cost and quality outcomes. - Shape utilization strategies across a diverse provider network. - Operate in a data-driven, clinically integrated environment. Equal Opportunity Employer Southeast Primary Care Partners is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

• Manage assigned patient A/R accounts, including follow-up on outstanding self-pay balances. • Conduct inbound and outbound calls to patients regarding balances, statements, payment options, and account resolution. • Collect payments via approved payment methods and accurately post transactions in the PM system. • Set up, maintain, and monitor compliant payment plans according to organizational policy. • Process and follow up on patient refunds as needed. • Perform follow-up on clinic requests related to patient balances, billing questions, or account corrections. • Review patient accounts in the PM system to ensure accuracy of charges, payments, adjustments, and insurance processing. • Read and interpret EOBs to explain insurance determinations, denials, patient responsibility, and payor adjustments. • Apply knowledge of major payor policies (commercial, Medicare, Medicaid) when addressing patient inquiries. • Identify billing discrepancies and escalate issues appropriately for resolution. • Provide clear, empathetic, and professional communication to patients regarding sensitive financial matters. • Educate patients on billing statements, insurance processing timelines, and financial responsibility. • Handle escalated or complex patient inquiries related to balance or insurance explanations. • Maintain detailed and accurate account notes documenting all patient interactions and actions taken. • Ensure all collection activities comply with federal and state regulations (including FDCPA where applicable), organizational policies, and Financial Assistance Program (FAP) guidelines. • Follow call handling, scripting, and documentation standards to ensure consistency and quality. • Protect patient confidentiality and adhere to HIPAA requirements at all times. • Meet or exceed individual performance goals related to call volume, collections, payment plans, and account resolution. • Participate in quality reviews, coaching, and ongoing training. • Collaborate with team members and supervisors to support workflow efficiency and service level goals.