Pay Range: $32.46- $53.56

Reporting to the Director of Revenue Cycle, the Medical Billing Manager will oversee all functions of Samaritan Medical Center and Affiliates Billing Department to maximize revenues, provide analysis, create written processes and provide training and education efforts of the department.

Duties and Responsibilities

The Medical Billing Manager will direct and manage the daily operations of the departmental billing office to ensure the preparation, posting and collections of all billable encounters are completed in an accurate and timely manner.The successful candidate will supervise and facility all processes, policies, procedures and be responsible for the overall team effectiveness and motivation.

• Collaborate with cross-functional teams to resolve billing issues and ensure timely payments.

• Manage transitions to changing billing and coding environments through all payor sources. (Medicaid, Medicare, Commercial, Private Pay, Military, etc.)

• Train billing staff in use of new codes/modifiers

• Establish new processes to accommodate change as needed to maintain efficient workflow and uninterrupted collections.

• Maintain current information on Third Party payors, and keep staff informed of insurance provisions and changes.

• Monitor and track billing and cash collection goals and develop action plans as needed to ensure organizational goals are met.

• Monitor aged accounts, working with staff to address oversights or problems within payors.

• Ensure staff follow the process to work aging accounts and address any identified issues with insurances.

• Become superuser for billing systems utilized as well as clearinghouses.

• Hires new billing staff as necessary and reviews performance evaluations prepared by Supervisors.

• Monitor, trend and analyze pre-bill edits and collaborates with intra-departmental team members to identify root cause.

• Assists with compliance, education, accuracy in charge capture and improvement in the revenue cycle processes as identified through revenue cycle audits and root cause analysis.

• Ensure billing practices are compliant with payor rules and regulations.

• Prepare and present financial reports and analytics to senior management on a regular basis.

Skills

· Ability to manage numerous systems.

• Knowledge of healthcare codes including CPT, ICD-10, HCPC, DRG, and ability to correctly use and apply codes in operational setting.

• Proficiency with MS Excel, Word and PowerPoint

• Knowledge of third-party payer rules and requirements, computer operations and electronic interfaces related to charge documentation, capture and billing is required.

• Extensive knowledge of all payment methodologies including, Ambulatory Payment Classification (APC), Diagnosis Related Grouper (DRG) and Outpatient Prospective Payment System (OPPS) reimbursement structures, as well as pre-bill edits including Outpatient Coding Edits (OCE)/Correct Coding Initiative (CCI) edits and Discharged Not Final Billed (DNFB)

• Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously

• Possess strong analytical, interpersonal, written, and verbal communication skills

• Knowledge of charge capture, reconciliation, error management operations and overall revenue cycle operations required

Education/Experience

• Minimum of (5) to (10) years in Patient Accounting required, preferable in a hospital setting

• Knowledge of hospital billing and reimbursement of insurance as well as third-party billing

• Bachelor’s degree from a recognized college or university in business, healthcare, or a closely related field preferred.

o A combination of education and appropriate experience may be substituted for the degree requirement.