Manager of Billing Services

The Billing Services Manager oversees the daily operations of the Billing Services Supervisor(s) and their teams, fostering a highly engaged and productive workforce through coaching, guidance, and regular assessments of staffing and productivity needs. This role emphasizes supervision and management of all aspects of the billing department, including claims processing, revenue monitoring, denials management, and quality improvement initiatives. The manager will collaborate effectively with other managers and administration to ensure timely billing, accurate reporting, and efficient patient account management.

Qualifications

Education/Experience/Skills:

• Bachelor's degree or an equivalent combination of education and four years of experience in a related field.
• A minimum of three years in patient financial services or a related area, including at least one year in a managerial role within healthcare.
• Proven experience in the healthcare revenue cycle.
• Familiarity with revenue cycle functions such as registration, coding, billing, and follow-up.
• Proficiency with IT systems relevant to finance and healthcare revenue cycle.
• Knowledge of Meditech revenue cycle systems is preferred.
• Commitment to maintaining confidentiality regarding patient care and employee information, while upholding HIPAA regulations and professional ethics.
• Knowledge, Skills, and Abilities Required:
• Exceptional communication skills to engage with patients, physicians, family members, and co-workers, emphasizing a customer service focus and positive language.
• Ability to utilize interpersonal styles and techniques to gain acceptance of ideas and modify behavior as needed to accommodate various tasks and stakeholders.
• Strong leadership qualities and objective analysis skills with a proactive approach to problem-solving.
• Analytical skills to identify issues and opportunities, draw conclusions from diverse data, and develop effective solutions.
• Capacity to thrive in a fast-paced, dynamic environment with adaptability and flexibility.
• Proficient in mentoring and guiding team members effectively.
• Strong computer skills, including proficiency in MS Office and EMR software.
• In-depth understanding of department processes and financial workflows, including scheduling, prior authorization, registration, coding, billing, and follow-up.
• Creative and critical thinking skills to swiftly address atypical issues and challenges.
• Ability to work independently with minimal supervision while making informed decisions within established operational guidelines and policies.

Responsibilities

• Lead recruitment, scheduling, supervision, retention, and performance evaluation of billing and collections staff.
• Provide mentorship to ensure staff competency in hospital billing processes and progression of skills, aiming for a team engagement score at or above organizational goals.
• Implement a training program specifically on hospital billing regulations and best practices to ensure compliance and efficiency in tasks related to Accounts Receivable management.
• Foster an engaged and knowledgeable billing team by holding regular meetings to review hospital billing processes, changes in regulations, and operational updates.
• Conduct performance appraisals with a focus on billing accuracy and collections efficiency, ensuring that employees meet or exceed established performance benchmarks for timely billing and collections.
• Prepare and present relevant training materials to enhance organizational performance.
• Promote effective teamwork within the billing and collections teams and with other revenue cycle and clinical staff.
• Facilitate regular cross-department training sessions to ensure that all team members understand the revenue cycle, resulting in improved accuracy in upstream processes and a reduction in billing errors and denials.
• Assess and allocate workload appropriately to ensure high-quality work and meet hospital billing performance standards.
• Set and monitor KPIs for claims submission accuracy and time to payment, targeting claims submission accuracy and an average payment turnaround time from claim submission.
• Regularly review performance data to proactively address any declines in productivity or performance.
• Communicate updates regarding billing processes and payer requirements promptly to the team to ensure compliance with hospital policies and timely claims submission.
• Maintain a system for tracking changes in payer policies and ensure that all relevant team members are informed within 24 hours, minimizing claim denials and delays in payments.
• Identify and act on opportunities to enhance partnerships with insurance providers and internal departments such as other revenue cycle, clinical and administrative areas.
• Work towards a goal of decreasing disputes with payers by fostering open lines of communication and establishing regular check-ins with key insurance contacts.
• Safety and Compliance: Ensure compliance with federal, state, and hospital regulations regarding billing and collections to maintain a secure and effective working environment. Aim for a 100% compliance rate during audits by conducting regular training sessions on HIPAA, insurance regulations, and hospital billing practices for all staff.
• Leverage all the hospital's revenue cycle management software to streamline billing operations and improve efficiency.
• Optimize the use of analytics to monitor accounts receivable and track key performance indicators, leading to decreased payment cycle times.
• Apply rigorous problem-solving principles to enhance hospital billing processes, with a focus on minimizing claims denials and enhancing collections.
• Set a goal of reducing the overall claims denial rate through targeted intervention strategies.
• Assist in developing and managing the billing department’s budget to ensure that operations remain cost-effective and in line with financial targets.
• Monitor expenses with a goal of staying under budgeted figures, identifying and recommending cost-saving measures related to billing operations without compromising service quality.
• Implement strategies to achieve financial objectives while maximizing collections efficiency.
• Set targets for cash collections and reduce accounts receivable aging, ensuring a focus on high balance and aged accounts.
• Generate detailed reports on key billing and collections metrics, such as overall accounts receivable days, percentage of claims denied, and average initial claim submission to payment time.
• Develop actionable plans based on these metrics to enhance revenue cycle operations and monitor the effectiveness of implemented strategies regularly.
• Collaborate with stakeholders, including hospital administrators, clinical staff, revenue cycle teams, and IT teams, to enhance billing processes and integrate new technologies.
• Aim to successfully implement system upgrades or new software tools each year that improve accuracy in billing and enhance overall revenue cycle efficiency, with measurable tracking of positive outcomes post-implementation.

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned.   This position reports to the Director of the Revenue Cycle. 

HIPAA:  This position will have access to the Protected Health Information described below, in order to carry out the duties related to the position at Hays Medical Center, based on the following criteria:

• Primary – required (routine) to do the job;
• Secondary – required for the job, but mostly by exception; and
• None – no approved access

Description of Information:

• • Primary
    • Financial Information/Insurance (information related to insurance, billing, and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates
    • Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion
    • Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical
  • Secondary
    • Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes

Infection Control: This position will include initial and ongoing training in dealing with infection control. Training could include, but is not limited to, blood-borne pathogens, bodily fluids, and biohazardous materials, as it applies to your daily work environment.

Patient Interaction: Occasionally