The person who fills this position will plan, direct and coordinate all activities of the billing department. S/he will support the organization through daily management of the billing staff responsible for medical and dental, hospital inpatient, and special programs billing. S/he will also manage the billing and collection/denials management processes for all clients and third party payers.
We are seeking an efficient, process-driven individual with strong leadership skills and a desire to drive improvements; strong experience and knowledge in managing electronic billing processes a participative management style advocating team concept who is results and profit oriented with the ability to balance other business considerations; must have the ability to establish credibility and be decisive,and be able to recognize and support the organization’s preferences and priorities; The person who fills this position will have excellent problem-solving, organizational, time management and interpersonal skills and a strong ability to create a comfortable, supportive learning environment. This person also needs advanced knowledge of practice management systems (preferably NextGen) and Excel.
Some of the essential job functions for this position are:
- Perform full range of supervisory duties for all billing staff
- Be responsible for setting work expectations for the billing staff related to insurance claims, patient balances, delinquent accounts, and payment posting.
- Monitor completion of daily deposits, reconciliation of daily activity, timely claims submittal and patient statement processes
- Monitor and manage Accounts Receivable trends, including Days Outstanding, cash receipts, bad debt, and AR trends
- Work with clinic staff to monitor and manage Denials Management trends
- Monitor, train and adhere to payer regulations, including strong knowledge of Medicare, Medi-Cal, and FQHC regulations
- Maintain department policies, procedures and training program
- Act as active member of the Revenue Cycle team, developing and implementing revenue management strategies
- Implement feedback mechanisms for resolutions of most frequent/costly denials in a timely manner to improve billing efficiency and cash flow
- Ensure that the charge capture process functions efficiently, that all charges are captured and submitted completely, timely, and accurately.
- Implement and monitor coding issues and trends from payer sources, system, and overall needs of the department
- Oversee electronic claim submission, monitor problems that arise, communicate and resolve issues with software vendor
- Coordinate NextGen end of month closing
- Develop and maintain a strong working relationship between Billing and Operations departments
- implement systems to audit billings and posting of payments, collections and denials, to ensure accuracy of accounts receivable, timely visit adjudication, and revenue maximization
- Review all Payer Contracts and Contract Amendments (including Medicaid, Medicare, Managed Care Plans); set up and revise procedures as necessary
- Participate in and emphasize patient centered medical home processes
High school graduate or equivalent with minimum 5 years healthcare/medical experience; 4 years experience with billing fee-for-service payers including Medicare and HMO programs; minimum 3 years supervisory experience gained through increasingly responsible management positions; valid driver’s license and vehicle insurance, and reliable transportation. Preferred are a Bachelor’s degree in business or related healthcare field; CPC credentialing and previous experience in a medical or healthcare clinic, FQHC