Third-Party Billing Revenue Cycle Manager

GENERAL SUMMARY

As a Third-Party Billing Revenue Cycle Manager, you will be managing the billing and collections team, ensuring timely generation of claims and collections of outstanding accounts receivable dollars from the existing client base, and all other aspects of collections, resolving insurance billing problems and reducing accounts receivable delinquency.

This position ensures the confidentiality, security, and accuracy of records, and promotes positive employee, customer, and community relations. Strong written and verbal communication skills are required and outstanding customer service to fellow employees, customers, vendors, etc. is expected. Regular attendance is required, and on occasion, later hours or weekend time may be required with project deadlines and a neat well-groomed professional appearance is essential at all times.

PRIMARY RESPONSIBILITIES

Primary responsibilities are the basic job duties that an employee must be able to perform. This list of responsibilities is intended to be representative of the duties performed within this classification. The omission of a function does not preclude management from assigning duties not listed if such duties relate to the position.

• Maintains knowledge of the operational details of all positions in the Billing department, which includes but not limited to insurance claim submission, clearinghouse and payor claim rejections, payment posting, insurance claim denial management.
• Initiates modifications of all procedural paperwork related to accounts receivable-encounter forms, billing verifications, etc.
• Meets with Billing and Collections staff monthly to analyze A/R reports, days in receivable, and collection statistics.
• Performs weekly billing audits to ensure timely and accurate processing of charge and payment posting.
• Conducts detailed audit of Explanation of Benefits forms from commercial and managed care payers at least biweekly; prepares or presents results to Executive Management.
• Meets with Billing staff monthly to discuss key issues, overall accounts receivable performance, and opportunities for improvement.
• Trains and oversees performance of Billing and Verification staff; assists with recruitment, discipline, and termination.
• Monitors overall workload in the department and distributes work; accordingly, ensures all posts are filled in case of vacation and sick days.
• Maintains fee schedule as well as CPT, ICD-10 CM, adjustment, payment, and payor files in the computer system.
• Maintains and distributes payment contracted schedules as received from contracted carriers; inputs/updates schedule into computer system.
• Requests payment schedules from contract carriers as needed.

• Prepares fee/payment comparative report quarterly.
• Maintains carrier contract files and the Compliance Binder.
• Completes all credentialing applications and reapplications as requested.
• Seeks and recommends ways to use technology to improve operational efficiency.
• Maintain patient confidentiality by following the HIPAA Compliance Plan established by the practice.
• Attends all meetings as requested and performs any additional duties as requested.

COMPETENCIES

• Knowledge of tribal, state, and federal patient privacy of information legislation.
• Maintain patient and billing records according to Tribal policy.
• Demonstrated ability to read and understand provider's handwritten narratives using detailed medical terminology asking for clarification when needed to correctly enter into the database.
• Working knowledge of Billing Software & Computer Database systems.
• Knowledge of ICD 10 -CM/CPT coding system to correctly enter data including the ability to verify data input and correct errors.
• Knowledge of billing procedures, regulations and standards and ability to apply them to Medicare, Medicaid and/or other private insurance carriers.
• Knowledge of the organization and purpose of the documentation used to bill and collect.
• Ability to gather data, compile information, and prepare reports.
• Maintain courteous and effective relationships with patient/clients and the general public, and work with a diverse group of people.
• Ability to maintain confidentiality of patient records according to tribal and federal patient privacy of information legislation.
• Ability to maintain quality, safety, and infection control standards.
• Ability to meet production standards.
• Ability to communicate effectively both orally and in writing.

MINIMUM QUALIFICATIONS

EDUCATION AND EXPERIENCE:

• Minimum of five years' experience in medical billing and coding.
• Certificate in Medical Insurance Coding and Billing
• One year of supervisory experience
• Proficient in using billing and related software.
• Strong professional communication skills (written and verbal).
• Proven knowledge of Rev, CPT, and ICD-10 CM coding (medical, dental, SUD, MH preferred).
• Integral knowledge of the A/R process.
• Proven managerial success in analyzing A/R reports.
• Proven successful management skills.
• Successfully passed a pre-employment drug screen and criminal background check.

PREFERRED QUALIFICATIONS

• Knowledge of the Nisqually Indian Tribe's history, customs, traditions, and ability to demonstrate cultural sensitivity.
• Experience working with Federally Recognized Tribes.

SUPERVISION

This position supervises, trains, and evaluates medical and billing coding specialists.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by a team member to successfully perform the essential functions of this position. While performing the duties of this position, the employee is frequently required to stand; walk; use hands to finger; handle; feel; or grip objects, stretch and/or reach with hands and arms; stoop; crouch or work in cramped or awkward positions; repetitive motions. This person may regularly lift and/or move up to 30+ pounds. Specific vision abilities required by this position include close vision, distance vision, depth perception, and ability to adjust to focus.