POSITION SUMMARY

Management position responsible for directing the billing and coding functions of the Corporate Billing Office to ensure maximization of cash flow while improving patient, physician, and other customer relations.

ESSENTIAL FUNCTIONS

• Oversees the operations of the billing department up through the point of claims submission, including but not limited to medical coding, charge entry, and claims submissions.
• Serves as the practice expert and go to person for all coding and billing processes. Acts as a liaison with clinical and front desk operations across the practice to ensure consistent performance, coordinating communication and execution effectively with the POD Administrators.
• Plans, analyzes, directs, and audits patient insurance documentation, workload coding and billing, and data processing to ensure accurate billing and efficient account collection, with the goal of over 98% “clean claims".
• Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings. Works closely with the Reimbursement Manager to ensure excellent operational coordination across the Central Billing Office.
• Collects, compiles, and delivers accurate statistical reports as required by the CFO.
• Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
• Participates in the development and implementation of operating policies and procedures.
• Participates in the design and implementation of specific systems to enhance revenue and operating efficiency. Responsible for maintaining system tables, including but not limited to Charge/CPT codes, Referring Physicians, and other tables required for submitting clean claims.
• Works with the Reimbursement Manager on analyzing trends impacting charges, coding, collection, and accounts receivable, and takes appropriate action to realign staff and revise policies and procedures.
• Keep up to date with carrier rule changes and distribute the information within the practice.
• Obtains and maintains physician credentialing with insurance payors and facilities.
• Understands and remains updated with current coding and billing regulations and compliance requirements.
• Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
• Supervises billing office personnel, which includes work allocation, time off requests, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
• Provides, oversees, and/or coordinates the provision of training for new and existing physicians, billing, and clinic staff on applicable billing operating policies, protocols, systems and procedures, standards, and techniques.
• Maintain key role in payor contract negotiation and holds direct responsibility for maintaining knowledge of current payor contracts, obtaining and maintaining contracts and ensuring payor contracts are effectively loaded in all appropriate systems.
• Performs other miscellaneous duties as assigned.

KNOWLEDGE | SKILLS | ABILITIES

• Requires strong managerial, leadership, and business office skills, including critical thinking and the ability to produce and present detailed billing activity reports.
• Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of TN, GA, VA and Federal payer regulations.
• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
• Knowledge of business management and basic accounting principles to direct the billing and coding office.
• Possess excellent negotiation skills to successfully negotiate payor contracts for SERA and to have the tact required for securing payment or discussing patient's finances.
• Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
• Skill in developing, implementing, and administering work processes.

Education | EXPERIENCE

Education

• High School Diploma or GED Equivalent REQUIRED
• Bachelor or Associate level degree in Business Administration or related field PREFERRED
• Certified Coder PREFERRED
• Bachelor’s Degree PREFERRED

Experience

• Five (5) or more years in the underlying job functions to be supervised REQUIRED
• Minimum of Two (2) Years' Experience in a similar central billing mgr. role STRONGLY PREFERRED