Essential Functions

Leadership

• Lead and manage billing team, providing guidance, training, and support.
• Responsible for all time & attendance functions of the billing team, to include ensuring adequate staffing coverage to meet operational needs.
• In partnership with Director of Administration, identify the need for new or modified Standard Operating Procedures (SOPs).
• Provide training to current employees to include retraining, rollouts of new Standard Operating Procedures (SOPs), new workflows, and/or new systems.
• Ensure all direct reports uphold company policies and standards.
• Conduct 1:1 with employees as appropriate to provide ongoing feedback and support.
• In partnership with Director of Administration, facilitate recurring team meetings with relevant and business driven agenda items.
• Report, in a timely manner, to the Director of Administration, if there is a problem in meeting task expectations within established SLAs.
• Must maintain the knowledge and ability to provide additional support to team members by having full working knowledge of the billing cycle process.

Billing Operations

• Assists in the resolution of patient complaints and concerns and resolves.
• Generate and analyze regular reports on key performance indicators, presenting findings to upper management.
• Oversee check posting, accounts receivable, charge entry, edits processing, and customer service.
• Demonstrate advanced proficiency in Athena billing modules.
• Oversee credentialing process.
• Oversee billing processes, ensuring accuracy and compliance with regulations.
• Oversee the timely submission of accurate claims to insurance providers.
• Investigate and resolve claim rejections and denials, implementing corrective measures to prevent reoccurrence.
• Work with Director of Patient Services to identify and implement strategies to enhance revenue generation.
• Implement data-driven strategies to improve billing efficiency and reduce errors.
• Advising and training physicians and staff on medical coding.

Other Duties

• Employees may be asked to take on other duties as assigned and escalate any concerns to leadership or Human Resources.

Knowledge, Skills and Abilities

• Excellent oral and written communication skills.
• Demonstrated understanding of Medicaid and various insurance company systems.
• Knowledge of healthcare reimbursement and third party payer regulations and medical terminology required.
• Working knowledge of regulatory requirements pertaining to health care operations and their impact on operations.
• Excellent computer skills i.e., Microsoft Office suite, ability to navigate websites and experience with practice management software knowledge.
• Ability to multi-task and perform well in stressful situations.
• Time management and strong organizational skills.
• Knowledge of general administration in a healthcare setting.
• Can work independently and with a team.

Experience and Educational Requirements

• High school diploma and related undergraduate degree required. May accept equitable experience in lieu of degree.
• At least three (3) years of medical billing experience.
• Recent direct supervisory experience in a professional setting – leadership experience within a medical billing/patient accounts service line is preferred.
• Experience with Athena strongly preferred.
• Demonstrated understanding and compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Working Conditions

• This position is primarily based in an administrative office setting.
• Must be able to remain in a stationary position 50% of the time.
• Continuously operates a computer and other office productivity machinery, such as a calculator, copy machine, printer, and phone.
• The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

Capital Area Pediatrics ("the Company") is a proud Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, gender identity, pregnancy, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status, or any other basis covered by appropriate law. All employment decisions are based on qualifications, merit, and business needs. The Company does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of the Company and the Company will not be obligated to pay a placement fee. Employees must be able to perform the essential functions of the position satisfactorily and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions of their job, absent undue hardship. Furthermore, job descriptions typically change over time as requirements and employee skill levels change. The Company retains the right to change or assign other duties to this position.