Position: Billing Manager
Summary: This position is responsible for helping to maintain the financial health of Heartland Health Outreach as directed by the Senior Director of ISB. This includes, but is not limited to the management of personnel engaged in third-party billing, collection of third party payments, cash application, insurance verification, charge and payment reconciliation inclusive of payment monitoring via third party payer system. The position is responsible in a leadership role in the collaboration with Senior Director of ISB and Billing Coordinating staff to establish, monitor, planning and management of departmental goals. Lead in the review and monitoring of policies and procedures, and ensuring the observance of governmental and system compliance around revenue cycle management and reporting. I ndividual accountabilities and work volume will be established through the development of annual Success Objectives, within the framework outlined below.
Billing and Revenue Cycle Management Responsibilities
- Directs and supervises the billing operations to ensure patient accounts are accurately prepared, billed and collected within acceptable time limits.
- Support and maintains electronic billing master files setup and systems that support electronic billing and electronic remittance posting.
- Manage and oversight of define workflows defined to support collection of self pay and third party payer sources.
- Manages system administrative functions associated with billing; and addressing complaints and resolving problems associated with participant billing in the revenue cycle management.
- Develops long and short-term goals to ensure adequate equipment, staffing and resources for present and future demands of the department.
- In collaboration with Senior Director of ISB defined, monitor, measure and report on defined quarterly billing quality measures
- Coordinates with care team(s) to improve collaboration and processes in areas that impact effect revenue cycle management.
- Supervision of all cash application activities.
- Research, define, approve and train staff on all new billing procedures, charges, etc; inclusive of newly added services or revenue streams.
- Assists with the development of new procedures of all new billing ventures. Maintains contacts with third party agencies and other health care facilities, etc. to establish network.
- Develops and maintains relationships with internal departments, organization-wide contacts and external contacts in order to meet department goals and objectives.
Revenue Compliance and Administration
- Monitors compliance and accuracy of contractual special arrangement billing assuring regular invoicing and collection activity.
- Demonstrates a thorough understanding of contractual obligations and other pertinent matters as set forth in the business transactions of the Organizations.
- Departmental leader in the coordination of activities with third party agencies, insurance companies, organization departments and defining billing guidelines to assure compliance.
- Responsible for provider credentialing application with respective third party carriers (e.g.: Medicaid, Medicare, private insurance companies).
- Responsible for agency credentialing application on behalf of HHO with other private third party carriers as determined by Senior Director of ISB.
- The Billing Manager is responsible for the overall direction, coordination, and evaluation billing staff personnel.
- The Billing Manager carries out supervisory responsibilities in accordance with Heartland Alliance’s policies and applicable laws. Responsibilities include full cycle employee management and development: Manages and trains all employees in the department; Monitors and documents performance of staff; Conducts performance reviews on all direct reports; Develops billing team goals and success objectives for all employees.
Qualifications : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Manages workflows and performance to meet revenue, quality and efficiency targets.
- Monitors and conducts periodic staff audits to assure defined departmental workflow to ensure efficient work patterns.
- Conducts periodic departmental staff meetings and participates as an active leader in the monthly Registration & Billing Meeting.
- Performs other job-related duties as assigned.
- Education and/or Experience: Associates degree or higher; five years of related medical billing experience with training in ICD 9 and CPT coding required; billing supervisory experience preferred.
- Language Skills: Ability to read, analyze, and interpret common technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from employees, regulatory agencies, or members of the business and financial communities. Ability to effectively present information to top management, public groups, and Board of Directors.
- Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
- Reasoning Ability: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
- Computer Skills : To perform this job successfully, an individual should have experience with Medical Practice Management System/s and be willing to acquire knowledge of Centricity Practice Solution/EHRS; CIS, CareWare, Microsoft Office; Internet Explorer; and project management software.
- Certificates, Licenses, Registrations: Membership in related professional organizations is highly desirable.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is regularly required to sit and talk or hear.
• The employee is frequently required to use hands to finger, handle, or feel and reach with hands and arms.
• The employee is occasionally required to stand and walk.
• The employee must occasionally lift and/or move up to 25 pounds.
• Specific vision abilities required by this job include close vision and ability to adjust focus.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
•The noise level in the work environment is usually moderate.
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