Billing Manager

Position Information: Responsible for overseeing the entire billing process related to client service delivery.   This includes managing the collection and processing of billing and reports for funders or payers, ensuring accurate, timely invoicing and payment collection, managing billing staff, developing procedures, optimizing revenue cycles, resolving complex issues, reporting on financial metrics, ensuring compliance, and maintaining strong internal/external customer service to improve client, clinicians and other customer relations, and for smooth cash flow.

Essential Duties and Responsibilities:

• Oversee the operations of the billing department, encompassing claims submission, payment posting, accounts receivable follow-up, collections, and reimbursement management; monitor billing policies and procedures, and workflows for efficiency and accuracy.
• Responsible for monitoring Behavioral Health Billing Solutions, LLC (BHBS) deliverables under the current contract and scope of work.
• Serve as the practice expert and go to person for all coding and billing processes.
• Ensure that all data entered into the EMR systems goes through desk review procedures before submission to funders for payment; responsible for updating and maintaining these procedures to meet the needs of the Agency.
• Maintain contacts with other departments to obtain and analyze additional client information to document and process billings.
• Analyze billing and claims for accuracy and completeness, follow-up with billers on work queues or pending claims, and ensure claims are submitted in a timely manner, received, and processed by payers.

• BHBS is the biller for CareLogic
• Agency billing staff is the biller for MethaSoft

• Prepare and analyze accounts receivable reports and insurance contracts with the Chief Financial Officer (CFO). Collect and compile accurate statistical reports.
• Document and track billing denials. Develop an action plan to address the denials for expedient and timely resolution.
• Provide guidance to departmental staff to resolve issues related to billing errors, collections, and/or denial processing techniques. 
• Review and secure CFO’s approval for billing refunds.
• Secure patient account data during compliance reporting to Agency Finance and funders in the most efficient manner possible and in accordance with HIPAA rules.
• Audit current procedures to monitor and improve efficiency of billing according to County Board and other funders’ standards, insurance regulations, and according to first party payment policies established by the Agency.
• Oversee Cash Receipts process according to Agency policy.
• Responsible for payment posting of electronic and paper remittance advices (RAs) to EMR systems, reconciling payments to billing in EMR systems, and managing accounts receivables.
• Ensure clients’ financial entitlements are accurate and up to date.
• Recruit, train, supervise, and motivate department staff.
• Responsible for the direction and productivity of all department staff according to job descriptions and standards outlined in performance expectations.
• Analyzes trends impacting charges, coding, collection, and accounts receivable, and takes appropriate action to realign staff and revise policies and procedures.
• Meets regularly with the Chief Financial Officer to discuss the status of work and management matters related to the department.
• Responsible for maintaining and reporting all billing statistics for The Crossroads Center.
• Serve as the first escalation for problem accounts and customer service complaints related to billing.
• Communicate with providers, clients, and health plan personnel to solve difficult billing issues.
• Responsible for providing summary back-up reports for claims paid, showing client assigned program, funding source, and service period by month.
• Maintain a library of information/tools related to documentation guidelines and coding.
• Oversee the clinician credentialing process and ensure that it is accurate and timely
• BHBS Perform clinician credentialing actions.
• Attend webinars and seminars to keep up on Medicaid, Medicare, and insurance changes.
• Keep up to date with all funders’ rule changes and distribute the information within the organization as warranted.
• Other duties as assigned.

Supervisory Responsibilities: Supervises the Patient Financial & Billing Department team to ensure accuracy, efficiency, and compliance with funding requirements.

Qualifications:  

• Billing experience required; Behavioral Health specific experience preferred. 
• Bachelor’s degree, preferably in business administration or related field; or associate’s degree, preferably in business administration or related field and at least 5 years of healthcare experience. 
• Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicaid and Medicare; strong knowledge of Ohio, Hamilton County and Federal payer regulations.
• Certified biller.
• Certified coder is a plus.
• Management experience required.

Skills:

• Strong leadership capabilities
• Financial acumen
• Business office skills
• Excellent verbal and written communication skills; skills in speaking with persons of various social, cultural, economic and educational backgrounds.
• Excellent negotiation skills, including the tact required for securing payment or discussing patient's finances, and enjoy working in a behavioral health care setting.
• Capable of working independently, performing non-routine functions and problem solving.
• Working knowledge of CPT, ICD-9 and ICD-10 codes, HIPPA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.  
• Sufficient knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Able to demonstrate attention to detail, good teamwork skills and have the ability to prioritize and to meet deadlines.         
• Expertise in Excel required.
• EHR software knowledge which includes but is not limited to CareLogic and Methasoft is a plus.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.

Physical Requirements:

• While performing the duties of this job, the team member is regularly required to talk, hear, stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls, and reach with hands and arms.  
• Frequently lifts or moves up to 10 pounds.  
• Occasionally lift files or paper weighing up to 30 pounds.
• Requires normal visual acuity and hearing.
• Requires manual dexterity sufficient to operate a keyboard, type at 60 wpm, and operate office equipment as necessary.

Working Conditions:

• Involve frequent contact with clients.
• Work may be stressful at times.
• Interaction with others can be constant and interruptive
• Contact involves dealing with individuals suffering from behavioral health disorders.

Note: This is not necessarily an exhaustive list of responsibili­ties, skills, duties, requirements, efforts, or working conditions associated with the job. While this list is intended to be an accurate reflection of the current job, the company reserves the right to revise the functions and duties of the job or to require that additional or different tasks be performed.