Job Purpose: Assists in managing the duties and operation of the Appeals, Payment Posting, and Collections teams. Oversees all management duties including personnel administration and operations management. Works with management to keep A/R within set targets. Provides technical billing oversight to Team Lead and staff members to assist in reviewing and appealing claims for all payers. Works collaboratively with other management team members.

· Oversees duties related to submission of claims and the appeal of denied insurance claims to all payers.

· Oversees duties related to processing/resolving of claim edits for clean claim submission.

· Interviews, hires, evaluates, disciplines, counsels and terminates employees as necessary.

· Oversees daily workflow to keep backlog at or within set goals.

· Oversees regular staff meetings to provide appropriate communication.

· Assists staff as necessary with insurance, appeals, and billing.

· Stays current on appeal issues, insurance rules and regulations, and coding rules and updates.

· Oversees the supervision of employee time sheets.

· Attends meetings to provide feedback on coding and payment/denial issues.

· Provides monthly production and other reports as requested.

· Oversees and manages processes in order to meet A/R targets.

· Reviews daily incoming appeals, post appropriate adjustments and oversees assignment of workload.

· Monitors AR daily to ensure claims are processed through timely.

· Provides feedback for problem resolution for appeals staff regarding denials and appeals including assisting with the implementation of process changes, ensuring appropriate usage of resources in order to ensure compliance with state and federal guidelines, etc.

· Utilizes developed policies and procedures to standardize daily operations of the appeals processes

· Identifies opportunities for process improvements.

· Educates/trains staff as needed to ensure consistent performance and adherence to standards.

· Has regular and predictable attendance.

· Adheres to Advanced Pain Care policies and procedures.

· Performs other duties as assigned.

· Familiar with standard concepts, practices, and procedures within the medical field including basic medical terminology

· Presents a professional image and customer focus

· Practices teamwork by helping others willingly and communicating in a professional manner

· Updates job knowledge by participating in educational opportunities; reading professional publications.

· Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements.

· Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

· Operates standard office equipment (e.g. copier, personal computer, fax, etc.).

MINIMUM QUALIFICATIONS

Education : Requires a high school diploma or GED. Undergraduate/graduate degree in a related field is highly preferred.

Experience : At least 5 years’ experience in medical office billing, and two years of management experience. Strong background in pain management preferred.

Environmental Conditions : Medical Office environment

Physical Conditions :

· Must be able to work as scheduled – typically from 8:00 – 5:00 M-F

· Must be able to sit and/or stand for prolonged periods of time

· Must be able to bend, stoop and stretch

· Must be able to lift and move boxes and other items weighing up to 30 pounds.

· Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.

KNOWLEDGE, SKILLS AND ABILITIES

· Clear and precise communication

· Knowledge of medical terminology, CPT, ICD-9 & 10 coding, collections for ambulatory surgeries, anesthesia and in-office procedures

· Knowledge of correct billing techniques, forecasting and the billing revenue cycle

· Effectively manages day by organizing and prioritizing

· Applies tactful principles and practices of dealing with the public

· Protects patient information and maintains confidentiality

· Familiarity with EMR systems and skilled in using Microsoft Office Suite

· Ability to work under pressure

Ability to hire, manage and discipline staff appropriately

SUPERVISION Reports to Revenue Cycle Director