Office Manager - Nexus Physician Services

POSITION SUMMARY:

The Nexus Physician Services Office Manager oversees the daily operations, administrative functions, and revenue cycle activities of physician practices within a specialty hospital system serving individuals with neurodevelopmental disorders, autism spectrum disorder, intellectual and developmental disabilities, traumatic brain injury, and complex medical and behavioral conditions. The role ensures efficient practice operations, exceptional patient and family experiences, regulatory compliance, and optimal financial performance. Working collaboratively with physicians, clinical teams, and operational leaders, the Manager drives service excellence, revenue integrity, quality outcomes, and continuous process improvement. The position serves as a key liaison between providers, staff, patients, caregivers, and support departments to support accessible, patient-centered, and financially sustainable care delivery.

JOB-SPECIFIC RESPONSIBILITIES:

•Service

oConsistently supports and communicates the Mission, Vision, and Values of Nexus Health Systems

oUpholds the Standards of conduct and corporate compliance

oDemonstrates honest behavior in all matters. To the best of the employee’s knowledge and understanding, complies with all Federal and State laws and regulations.

oMaintains the privacy and security of all confidential and protected health information. Uses and discloses only that information which is necessary to perform the function of the job.

oAdheres to all Nexus Health Systems policies on Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)

oCollaborates effectively with colleagues and other departments to ensure seamless service delivery.

oOversee day-to-day operations of physician offices including scheduling, registration, referrals, prior authorizations, insurance verification, medical records coordination, payment posting, and patient access functions.

oDirect and supervise front-office, administrative, patient access, and billing support personnel.

oDevelop, implement, and monitor workflows that improve operational efficiency, reduce patient wait times, and enhance provider productivity.

oCollaborate with physicians, advanced practice providers, nursing, therapy, behavioral health, and care coordination teams to promote integrated care delivery.

oEnsure staffing schedules support patient volume demands while maintaining appropriate service levels.

oLead patient access initiatives to improve timely appointments and continuity of care for medically and behaviorally complex patients.

oServe as operational liaison between physician practices, hospital departments, referral sources, payers, and community providers.

oManage office resources, supplies, equipment, and vendor relationships to support efficient operations.

oFacilitate resolution of operational concerns, patient complaints, and service recovery opportunities.

oSupport organizational strategic initiatives and physician practice growth opportunities.

•Excellence

oEstablish performance standards and accountability measures for physician office operations.

oMonitor operational metrics including scheduling utilization, provider productivity, access-to-care indicators, referral conversion rates, and patient throughput.

oDevelop and maintain standard operating procedures that promote consistency and reduce process variation across physician service locations.

oUtilize PDCA, and continuous improvement methodologies to improve operational performance and patient outcomes.

oPrepare operational dashboards, performance reports, and executive summaries for leadership review.

oMonitor workflow effectiveness and identify opportunities for automation, standardization, and process improvement.

oFoster a culture of accountability, teamwork, professionalism, and service excellence.

oEnsure accurate maintenance of provider schedules, clinic templates, referral management systems, and electronic health record workflows.

oSupport physician recruitment, onboarding, credentialing coordination, and practice integration activities.

•Patient Experience and Advocacy

oPromote a patient-centered environment that recognizes the unique communication, behavioral, sensory, developmental, and medical needs of patients with neurodevelopmental disorders and traumatic brain injury.

oEnsure staff utilize trauma-informed, family-centered, and neurodiversity-affirming engagement practices.

oMonitor patient satisfaction, grievance trends, and patient feedback to identify improvement opportunities.

oDevelop service standards that promote dignity, respect, accessibility, and equitable care.

oCollaborate with clinical teams to address barriers impacting access, communication, treatment adherence, or coordination of care.

oEnsure accommodations are implemented for patients requiring behavioral supports, communication assistance, or individualized care approaches.

oAdvocate for patients and caregivers throughout scheduling, referral, registration, billing, and care coordination processes.

oLead service recovery efforts and resolution of patient concerns in a timely and professional manner.

•Quality Assurance and Compliance:

oEnsures all activities adhere to healthcare regulations and organizational policies.

oParticipates in quality improvement initiatives to enhance service delivery.

oPromotes a culture of patient safety which results in the identification and reduction of unsafe practices.

oEnsure physician office operations comply with HIPAA Privacy and Security Rules, CMS requirements, payer regulations, state healthcare regulations, and organizational policies.

oOversee compliance with documentation, registration, consent, authorization, release of information, and patient financial responsibility requirements.

oMonitor adherence to Medicare, Medicaid, commercial insurance, and managed care payer guidelines.

oCollaborate with compliance, health information management, coding, and revenue cycle teams to support auditing and corrective action initiatives.

oEnsure accurate implementation of CPT, HCPCS, ICD-10-CM, modifier usage, and payer billing requirements.

oMonitor denial trends and implement corrective actions to reduce compliance and reimbursement risks.

oSupport organizational compliance programs, internal audits, risk assessments, and regulatory surveys.

oParticipate in incident reviews, root cause analyses, performance improvement projects, and corrective action plans.

oEnsure staff complete mandatory annual compliance, privacy, fraud and abuse, and patient safety training.

oMaintain readiness for accreditation and regulatory surveys including DNV, CARF, The Joint Commission, CMS, and state regulatory agencies as applicable.

oPromote ethical billing practices and adherence to federal fraud, waste, and abuse prevention standards.

•Professional Growth and Continuing Education:

oCompletes annual education requirements.

oMaintains competency, as evidenced by completion of competency validation requirements.

oMaintains competency and knowledge of current standards of practice, trends, and developments.

oParticipates in relevant workshops, seminars, and continuing education courses to stay current with industry trends, healthcare regulations, and best practices.

oRecruit, onboard, mentor, and develop physician office personnel.

oConduct performance evaluations, coaching sessions, competency assessments, and corrective action processes when necessary.

oEstablish individual development plans for direct reports.

oProvide ongoing education related to revenue cycle management, customer service, compliance, payer requirements, and operational excellence.

oEncourage participation in professional organizations, educational programs, and industry certifications.

oSupport workforce development initiatives focused on specialty populations including autism, IDD, behavioral health, and traumatic brain injury.

oMaintain current knowledge of healthcare regulations, physician practice management trends, reimbursement methodologies, and industry best practices.

oPromote interdisciplinary collaboration and professional accountability across departments.

•Finance:

oPromotes stewardship of hospital resources while ensuring quality patient care.

oOversee physician practice revenue cycle operations including charge capture, billing, claim submission, payment posting, denial management, accounts receivable follow-up, collections, and patient financial services.

oMonitor key revenue cycle indicators including:

Days in Accounts Receivable

Net Collection Rate

Gross Collection Rate

Clean Claim Rate

First Pass Resolution Rate

Denial Rate

Bad Debt Percentage

Cash Collections

oAnalyze reimbursement trends and payer performance to identify opportunities for revenue optimization.

oEnsure timely claim submission and resolution of payer denials.

oCollaborate with coding, compliance, and billing personnel to improve revenue integrity and billing accuracy.

oDevelop action plans to reduce aged accounts receivable and improve collection performance.

oMonitor operational expenses and identify cost-saving opportunities without compromising service quality.

oAssist with budget development, forecasting, productivity analysis, and financial performance reporting.

oSupport contract management initiatives and physician practice financial sustainability.

oEnsure adherence to revenue cycle management best practices consistent with AAHAM standards and industry benchmarks.

•Performs other duties as assigned.

POSITION QUALIFICATIONS:

EDUCATION:

•Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, Finance, Public Health, or a related field required.

•Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or related healthcare field preferred.

EXPERIENCE:

•Minimum of five (5) years of progressive experience in physician practice operations, ambulatory care operations, medical office management, or healthcare administration required.

•Minimum of three (3) years of leadership or supervisory experience required.

•Experience managing provider practice operations, revenue cycle activities, and administrative staff required.

•Experience working with specialty populations, behavioral health, developmental disabilities, autism spectrum disorder, or traumatic brain injury populations preferred.

•Experience with electronic health records, practice management systems, scheduling platforms, and revenue cycle technology required.

•Experience with Medicare, Medicaid, managed care, and commercial payer processes required.

SKILLS:

•Advanced physician practice operations management.

•Revenue cycle management and accounts receivable expertise.

•Strong leadership, coaching, and staff development skills.

•Financial analysis, budgeting, and performance reporting.

•Knowledge of healthcare compliance, privacy, and regulatory requirements.

•Process improvement and Lean methodology application.

•Effective conflict resolution and service recovery skills.

•Strong oral, written, and interpersonal communication abilities.

•Strategic planning and problem-solving capabilities.

•Ability to manage multiple priorities in a complex healthcare environment.

•Strong analytical and data-driven decision-making skills.

•Proficiency with EHR, practice management, scheduling, billing, and reporting systems.

LICENSURE/CERTIFICATION:

•Current Healthcare Compliance, Revenue Cycle, or Practice Management certification obtained within two years of hire if not currently held, required.

•Must maintain current certification in good standing during employment with this facility.