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Government Prog Mgr

Job ID R5281 Full / Part Time:Full time
Full / Part Time:Full time


The Program Manager, Hospital Patient Accounting is responsible for direct oversight of assigned payer units as well as the Hospitals Billing Operations Area in the absence of the Director. This encompasses servicing all hospitals under the Baystate Health umbrella to include BFMC, BWing and BNoble. Plans, organizes and directs daily operations of assigned units. The incumbent is expected to manage all patient disputes, service issues and charge concerns. The incumbent will form strong relationships with service areas, including risk management, reimbursement, access and medical records, as well as assisting in identifying the sources of issues, to work together on disputes and billing issues and timely resolutions of the issues, identify and streamline processes, and document all procedures as they are developed. The Manager will schedule and be in charge of meetings with payers with challenging accounts and processes. The incumbent supervises a moderate number of staff who is responsible for all billing and follow up. On an as needed basis incumbent provides management coverage for all hospital billing areas.

The Program Manager, Hospital Patient Accounting works closely with other Hospital Patient Accounting units, Baystate Health operational departments, and related contacts throughout all Baystate Health facilities to identify and resolve issues affecting prompt and accurate payment of claims. The incumbent must maintain a current working knowledge of assigned payer methodologies, regulations and guidelines, as well as online services to positively impact patient relations with Baystate Health. A key success factor for this position will be the ability to identify, introduce and implement new technology to enhance and improve the patient billing experience at Baystate Health.

Job Responsibilities: 

1) Coordinates billing and collection of all assigned payer processes; identifies, researches and ensures timely resolution of all patient disputes and charge issues, working with individual insurance companies as needed for positive results.

2) Coordinates and supervises procedures for managing assigned payers, including implementing all procedures and monitoring compliance of them.

3) Performs routine quality assurance on all assigned areas, identifying training opportunities to enhance staff performance.

4) Provide input to Senior Leadership regarding payer trends and feedback.

5) Suggest improvements to Revenue Cycle through Senior Leadership to improve the patient experience.

6) Develops and implements processes to meet new and revised Payer requirements.

7) Researches and resolves problematic accounts identified on various Ad Hoc reports, working with internal and external departments to improve quality. Assists with development and implementation of new reports as needed. Conducts high dollar and problematic claim review sessions with supervisory staff to ensure timely resolution of open issues. Participates in required regulatory or commercial audits.

8) Maintains comprehensive working knowledge of various software, including but not limited to: Invision, CSC, Trizetto, CIS, TRAC, SSI, Craneware, and PCON

9) Ensures that supervisory staff are properly reviewing and noting that contractual obligations are being met.

10) Approves and processes debit/credit adjustments, write-off requests and discounts.

Required Work Experience: 

1) None

Preferred Work Experience: 

1) None listed

Skills and Competencies: 

1) Required

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

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