Duties & Responsibilities:

• Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management
• Serves as the practice expert and go to person for all coding and billing processes
• Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection
• Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues
• Follow up on claims using various systems, i.e. practice management and clearinghouse
• Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings
• Prepares and analyzes accounts receivable reports, and weekly and monthly financial reports in concert with the Chief Executive Officer, Chief Operating Officer, and Controller. Collects and compiles accurate statistical reports.
• Audits current procedures to monitor and improve efficiency of billing and collections operations
• Ensures 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
• Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency
• Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures with the approval of Chief Operating Officer and/or Chief Executive Officer.
• Stay current with carrier rule changes and distribute the information within the practice.
• Understands and stays current with current coding and billing regulations and compliance requirements.
• Maintains library of information/tools related to documentation guidelines and coding
• Supervises billing office personnel, which includes work allocation, training, and being available for staff needs; motivates employees to achieve peak productivity and performance
• Provides, oversees, and/or coordinates training for new and existing billing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques
• Coordinates team member time off in a manner that does not negatively impact necessary daily functions.
• Other duties as assigned by the Chief Operating Officer and/or Chief Executive Officer.
• Performs all duties and responsibilities in an efficient, team-oriented manner

• Accountable for being knowledgeable and understanding of all aspects of the billing and coding staff duties to include:
• Entering patient demographics and insurance information
• Verifying patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance
• Responsible for reviewing operative reports within three business days of procedure/surgery
• Enter charges accurately according to insurance payers/contracts
• Submitting clean claims by attaching necessary documentation for payment
• Follow-up on electronic claims and paper claims
• Posting insurance payments to patient accounts
• Submit all secondary claims when necessary
• Refund money owed to patient or insurances
• Conducts self in a manner that reflects a positive representation of the company, and encourages others to do the same.
• Observes strict patient confidentiality