Position Summary

This position is responsible for supervising the billing process for clinic patients and third-party payers, ensuring timely and accurate research and resolution regarding billing issues and participating in revenue cycle initiatives. Should be knowledgeable of all state, local and federal financial assistance/eligibility programs available, to include Medicaid (all programs), Medicare, SSI (Supplemental Security Income), Non-Documented Alien Medicaid eligibility and the hospitals’ internal charity care requirements. This position assumes a leadership role for billing, claims and collections procedures, systems and operations. It also requires working under stressful conditions and irregular hours. Works with physicians, clinical staff, and other personnel to establish and maintain positive working relationships and to ensure efficient and effective operations. Manages current billing operations and secondary business office (SBO) vendor relationships, workflows, and accounts. Will also oversee and lead a billing productivity and quality program to ensure appropriate account resolution.

Work Schedule

Monday – Friday, 8-5 or as directed by Director, Business Office.

Primary Duties

Billing:

• Reviews and processes inpatient and outpatient bills to patients and third-party payers on predetermined schedules.
• Serves as liaison with third-party payers/agencies regarding billion (billing)/optimal reimbursement and any other billing/payment issues or questions.
• Develops recommendations to maintain efficient and effective billing processes.
• Maintains insurance company master list.
• Serves as liaison to nursing, emergency room, patients, families and physician’s offices regarding insurance benefits.
• Ensures all monetary transactions are processed in an appropriate and timely manner.
• Maintains accurate patient accounts including deductibles, co-payments, co-insurance, termination dates, effective dates, pending claims, etc.
• Ensures accurate data input of insurance information, company and plan information to patient accounts.
• Maintains current knowledge of reimbursement issues for Medicare, Medicaid, managed care and other third-party payers.
• Addresses and resolved billing inquiries over the telephone and in person.
• Serves as liaison with third-party payers regarding benefit information and preauthorization procedures.
• Monitors rejected claims, coordinates the research for the filing of appeals and/or reviews with third-party payers.
• Processes past-due accounts with insurance balances, contacting third-party payers and/or patients as necessary to facilitate the timely payment of past-due charges.

Other Business Office Duties:

• Oversees and leads billing productivity and quality analysis to ensure appropriate biller account resolution; provides education, corrective action plans, and documents team member progress.
• Oversees and serves as main point of contact for Payer Portal website user administration for billing, clinic, and patient access employees. This includes periodic monitoring to ensure appropriate security levels are assigned to end users.
• Serves as EMR Upgrade Subject Matter Expert and leads all upgrade weekly and scheduled workshop meetings. Serves as advisor to other revenue cycle EMR upgrade meetings, as necessary.
• Monitors Key Performance Indicators (KPIs), ensures appropriate escalation for metric and goal needs.
• Serves as key liaison for all denials workgroup / meetings, insurance payer / plan meetings.
• Monitors chargemaster system daily and coordinates updates from ancillary departments when needed or as needed with the Director of Strategic Payer Relations.
• Maintains patient files and insurance logs as defined in policy.
• Serves as back-up for self-pay accounts and collection functions.
• Performs other duties as directed to provide the most efficient service to the hospital/clinic in a manner which supports the overall effectiveness of the department and the hospital/clinic.

Supervisory Duties:

• Coordinates workflow to ensure all duties and documentation are kept current.
• Maintains and develops billing, collection, SBO, and other policies and procedures for business office operations.  Responsible for keeping all pertinent policy and procedure manuals current and available to all staff at all times.
• Works with management to identify staff training needs and schedule training as needed.
• Responsible for ensuring all required forms and office supplies are ordered and made available at all times.
• Makes recommendations to management for hiring and firing of employees in the department.
• Develops and maintains a team focused on “Delighting all Customers”.
• Assists customers with their questions regarding their patient accounts.
• Responsible for developing employee work schedules in a timely, efficient and fair manner.
• Makes himself/herself available to all shifts as needed.
• Responds to issues of harassment and discrimination per company policy.
• Completes employee evaluation(s) in a timely manner per company policy.
• Oversees employee attendance and disciplinary issues as first line of review.

Qualifications/Specifications

• Education: High school diploma or GED required. Associate degree preferred.

• Licensure/Certification: None required.

• Experience: Minimum of four years’ experience in medical insurance billing and/or claims processing/research required, preferably in a physician practice. Minimum of one year supervisory experience preferred.