The Billing Manager is responsible for the complex and comprehensive management, analysis, organizational development and education of all activities related to billing and collections. Essential to this position is a comprehensive understanding of all patient care services, registration and scheduling, billing activity and financial reporting in adherence to all guidelines.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
This is not intended to be an exhaustive listing of job functions. This job description in no way states or implies that these are the only duties to be performed by this employee. The employee is required to follow any other instructions and to perform any other duties as assigned by management.
1. Responsible for the development, implementation, and quality assurance of all policies and procedures as they relate to HN’s claims management operations to provide maximum efficiency and reimbursement.
2. Determines the goals and objectives within the billing team in support of HN’s strategic direction and within regulatory guidelines.
3. Reviewing and enhancing insurance verification, coding review, billing, collection, and cash posting processes for efficiency and best practices; ensuring systems are fully functional and maximized and recommending new processes to improve current work flow.
4. Actively monitors revenue cycle, track denial reports and days in AR.
5. Responsible for personnel development through training, coaching and supervision to include individual and team sessions.
6. Responsible for the timely review of requests for adjustments, overpayments, refund requests and providing regular and timely updates to the Director, Sr. Director and/or CFO.
7. Maintains a high level of technical knowledge and expertise regarding current and pending regulations, legislation and the potential impacts on the billing and collections process/systems used within the Network.
8. Responsible for the oversight, management and approval of billed SAL change requests in a timely manner.
9. Proactively reviews accounts that are 90 days and older, providing recommendations for the successful collections of outstanding payments in accordance with the RM procedure and in collaboration with the Collections Unit Manager.
10. Audits methods and procedures of accounts receivable functions to improve efficiency and collectability of services.
11. Researches and recommends techniques and programs that will promote quality assurance of the timely billing and collections of claims while maintaining current knowledge of relevant insurance coding and reimbursement issues.
12. Reports trends in payer submissions that could have an impact on billing procedures, revenue capture and contractual obligations.
13. Works collaboratively in the development and maintenance of applicable policies and procedures that result in: proactive internal communications and workflow with the Service Lines; accurate revenue capture, data entry, processing and proactive follow up to limit bad debt in collaboration with the SL Business Directors; managing internal controls to assure that billings are completed in accordance with regulatory requirements and contractual obligations.
14. Participates in periodic meetings with management teams as it relates to A/R, coding and revenue maximization.
15. Responsible for the development of proactive relationships with internal and external contacts that will assure the various funder streams are collected in accordance with the established timeframes and guidelines of the contract including bad debts when applicable.
16. Ensures routine and consistent metric reporting and processing requirements have been completed in a timely manner and are consistent with Network goals and objectives.
17. Participates in departmental projects as needed and required, including the development of new programs and services.
18. Assists with the annual audit process and its related activities as needed and required.
19. Regular and predictable attendance is an essential requirement of this position.
Educational / Talent Requirements:
1. Bachelor’s degree in finance or on of the following certifications: CPC Certification (Professional Coder), CPB Certifications (Professional Biller), or CCS-P (Certified Coding Specialist-Professional).
2. Strong leadership skills with an ability to motivate direct reports.
3. Excellent teamwork skills.
4. Excellent communication skills both written and verbal, and internal personal skills.
5. Strong organizational and time management skills.
6. Well-developed analytical and problem solving skills.
7. Ability to manage multiple priorities concurrently and make sound business data-driven decisions.
8. Demonstrated ability to work collaboratively with internal and external customers.
Work Experience Requirements:
1. 3-5 years’ experience in medical billing. Certified Coding Certification preferred.
2. 3-5 years of previous supervisory experience.
3. Demonstrated extensive knowledge of third party and government billing.
4. Demonstrated proficiency in the use of technologies: Microsoft Office, specifically in the use of Excel; Electronic Medical Records; insurance eligibility such as CHAMPS and Web-Denis; etc.
5. Ability to address performance or behavioral issues that are consistent with established policy and are supportive of the mission.
6. Ability to travel to other Hope Network sites when needed and requested; valid driver’s license with acceptable driving record.