Assistant Director of Billing and Claims
Bayless - Phoenix, AZ

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Type of Employment: Full time/exempt

Scope: The Assistant Director of Billing and Claims provides leadership to the departments of Billing and Registration & Eligibility in the areas of medical billing, cash posting, collections, financial assistance, new client registration, and referral processing, obtaining authorization & billing customer service. The medical billing staff report directly to this position. This position works closely with the management team as well as external vendors on matters affecting revenue cycles as well as customer service. This position is full-time and reports to the Director of Billing and Claims.

Essential Job Functions:

  • Plans and assists with the management of administrative office operations to include such functions as client registration, authorizations, billing, collections, and compliance.
  • Assists in the maintenance of client financial services programs to ensure compliance with current payments, rules, and regulations that impact agencies billing and collections process.
  • Direct & manage accounts receivable (A/R) to ensure accounts are collected appropriately from members, non-members, insurance carriers, Medicare, Medicaid, & other payer sources, and oversee resolution of third party denials, mentoring staff with reimbursement appeals and problems.
  • Monitors and evaluates current reimbursement/payment rules and ensures that regulatory changes impacting medical billing are anticipated and communicated to the clinical staff, and departmental billing personnel.
  • Provides expertise in fee for service medical client billing & collections around the related aspects of the revenue cycle, & the development of supporting policies & procedures.
  • Prepares financial reports and analyses to show progress or adverse trends, making appropriate recommendations or conclusions
  • Provides an evaluation of proposed claim related contracts to Executive team, coordinating and managing the implementation of executed contracts.
  • Assists in training and monitoring the outsourced billing agency to assure all contractual, state and federal billing and collection requirements are met and maintained.
  • Participate with the Director of Billing and Claims to assist with developing tools, streamlining functions and creating processes/reports, which will enhance our efficiencies as an agency and the reputation of our agency in the community.
  • Advise medical department regarding required state and federal rules and regulations as it relates to providing approved, quality services to our clients
  • Assess Federal, State and insurance product changes which can / will impact client records and billing, recommending and implementing EHR system updates, Provide analysis and consult with HIT Project Manager regarding the EHR system, participating in evaluating system enhancements and rolling out improvements
  • Assist with preparing information for quarterly & year-end audits
  • Assist in the management of a high functioning, high performing registration, eligibility, billing and collection team that can analyze & recommend ongoing improvements to processes, procedures, systems & reports (management, operations & transactions). Staff to include Supervisors, Billing Specialists, and Registration and Eligibility Specialists.
  • Recruit and maintain competent & productive team members who will develop high performers & take appropriate action with poor performers in accordance with agency policies.
  • Other duties as assigned

Provides leadership

  • Encourages and supports the process of team development. Is proactive in working to ensure positive and effective team functioning, and to address any issues that may interfere with a constructive team process.
  • Facilitates and participates in integrated team process.
  • Manages change effectively and positively.
  • Provides staff members with motivation and support to do their work
  • Facilitates open and clear communication among team members.
  • Supports decisions of the director and executive teams.
  • Coordinates with IT services as it relates to provider questions and concerns with regards to

electronic health record system

Supervision

  • Provides supervision which is regular, reflective, and collaborative in nature.
  • Addresses staff performance concerns directly and in a timely manner.
  • Documents these concerns and related supervisory conversations appropriately.
  • Documents supervision sessions according to required standards.
  • Responds to quickly top staff concerns, notifying supervisor/director and human resources of any

significant issues and changes.

Communication

  • Communicates in a positive, respectful, and courteous manner.
  • Practices active listening skills and uses partnering communication strategies to engage staff

members in collaborative problem-solving process.

  • Interacts with coworkers and the community to build productive and collaborative relationships to support the achievement of agency and program goals.
  • Understands and maintains private and sensitive information within the confines of need-to-know parameters.
  • Reviews email daily using various writing styles and formats to produce effective communication

including a clear purpose and intent.

  • Submits accurate and complete reports, forms, and other written information as required in

accordance with department and program standards.

  • Maintains a calendar that is available to supervisors and coworkers
  • Attends staff meetings and meetings as requested
  • Submits accurate and complete reports, forms, and other written information as required in

accordance with department and program standards.

Effective Team Player

  • Shares pertinent information with supervisor, contractors, and team members regarding work

progress, successes, barriers, concerns, and other areas that may have an impact on the department’s services or image, may affect relationships with key participating parties within the confines of need-to-know.

  • Plans, coordinates, attends and participates in staff meetings in accordance with department

standards and schedule. Supports the decisions of the director and members of the management team to staff, participants, and the community.

  • Prepares and participates in supervision that is regular, reflective, and collaborative in nature.
  • Recognizes the personal limits of competencies and expertise, seeks supervision and guidance

accordingly.

  • Maintains awareness of current professional information in the fields of activity, undertakes

regular and ongoing efforts to maintain competencies in the skills used, and incorporates and
demonstrates new knowledge and skills on the job.

  • Maintains a reasonable level of awareness of current professional information in fields of activity

and undertakes regular and ongoing efforts to maintain competence in the skills used.

  • Notifies supervisor of crisis situations, unusual incidents, and/or on-going problems within

appropriate timelines (including reports to Child Protective Services).

Education, Experience, and Qualifications:

  • A minimum of five years of managing a large scale (10 or more staff) medical related billing department
  • A minimum of 3 years managing a medical related customer service department.
  • Bachelor's degree or equivalent combination of education and work experience
  • High level of understanding of computer systems.
  • Detailed understanding of billing technical elements such as standard forms and data, coordination of benefit and third party liability billing and collection, electronic billing, data edit programs, and reimbursement methodologies
  • Strong financial knowledge in AR and reserve analysis, basic market analysis; staffing and financial reporting skills
  • Functional understanding of behavioral health care operations would be a plus
  • Excellent communication and negotiation skills
  • Demonstrated skill and prior experience in writing reports and making presentations of complex materials to a variety of audiences
  • Demonstrated leadership skills and ability to work independently.
  • Ability to unify and motivate teams to accomplish goals and objectives
  • Ability to resolve complex work related problems and foster interdepartmental cooperation and communication
  • Financial management skills, including the ability to financially analyze data for operations, budgeting, auditing, forecasting

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