Position Overview:

Provides oversight, guidance and management of the reimbursement operations for the FQHC in conjunction with the Chief Financial Officer. Performs various accounting functions on behalf of the FQHC as requested by the Chief Financial Officer in accordance with One Health’s policies and procedures. Responsible for the revenue cycle management assuring that the systems are in place to maximize collections and reimbursement for costs in providing health and dental services. The Billing Manager is responsible for creating, updating and monitoring written billing, credit and collections policies and procedures. This is a full-time salaried position working a minimum of 40 hours per week.

Essential Job Functions:

• Responsible for reporting all related revenue cycle functions to the CFO.
• Responsible for the overall billing operations and managing department staff
• Gathers, monitors, analyze and reports all pertinent financial information 
• Provides financial information as requested 
• Assists in preparing, submitting, and distributing the required financial/patient reports, including but not limited to: Medicare cost report, Universal Data System report and financial reporting grants, by request or deadline
• Audits the 340B pharmacy program regularly for appropriate billing and utilization 
• Performs audits of patient account to ensure accuracy and timely payment 
• Follows up on insurance billing to ensure timely receipt of payments 
•  Identifies problems on accounts and follows through to conclusion 
• Ensures that a monthly account of receivables over 30, 60,90 and 180 days are addressed within current policies and procedures
• Oversees the collection process 
•  Identify denial trends and develop solutions to reduce denials and increase payments 
• Processes insurance/patient correspondence, including denial follow-up within 48 hours of receipt 
• Maintains compliance with all laws, regulations and policies as defined by Federal, State and other bodies 
• Handles any unresolved patient complaints regarding billing in a timely and consistent manner
• Balances billing collections and daily batches
• Assures that all charges are updated and monitored in the current EPM system 
• Ensures ‘month end’ billing and close is completed by the 5 business day of the following month
• Runs the End of Month reporting and reviews reports with billing staff to determine priority workflow for current month 
• Works with credentialing specialist to assure that providers are properly credentialed with insurance companies 
•  Responsible for adding, deleting, and modifying provider accounts in the current billing system
• Assures that the sliding fees are current and utilized according to established policies
• Works with Front Desk as it relates to billing and sliding fee scale policies 
• Reviews, develops, coordinates, and implements all QI Billing Policies, to ensure changes are made throughout the year when necessary
• Cooperates in planning and development of projects as assigned 
•  Serves on any committee as assigned
• Travels as required for training, educational opportunities, satellite sites
• Complies with all One Health policies and procedures, including HIPPA 
• Effective interpersonal communication skills
• Ability to identify and counsel at-risk patients
• Ability to present a positive and professional attitude
• Ability to maintain confidentiality
•  Ability to identify problems and propose feasible solutions
• Knowledge of company’s policies and procedures
• Interpersonal/human relation skills
• Proficient telephone skills

Education and Experience:

• Associates Degree in related field preferred
• Community Health Coding and Billing Specialist Certification preferred
• Proficient in Microsoft Office Suite
• Bookkeeping skills and a working knowledge of medical billing software
• Understanding of private insurance rules and regulations
• Minimum 3 years experience in health care is preferred

Expectations:

• Adheres to all ONE Health Ohio Policies and Procedures.
• Conducts self in a manner that represents ONE Health Ohio core values at all times.
• Maintains a positive and respectful attitude with all work-related contacts.
• Communicates regularly with her/his immediate supervisor about Departmental and OHO concerns.
• Consistently reports to work prepared to perform the duties of the position.
• Meets productivity standards and performs duties as workload necessitates.
• Refrains from participation in harmful gossip, dysfunctional group interactions, and divisive behavior.
• Displays courteous and professional behavior in all interactions with the public.
• Works cooperatively with other staff members.
• Displays cheerful demeanor and makes positive comments when on duty.
• Displays flexibility in accepting, changing, or carrying out assignments.

Physical Requirements:

• Proficient telephone skills
• Ability to lift/carry up to 25 pounds
• Ability to push, pull, carry, lift, bend, twist, reach, sit, stand for lengthy periods of time; ability to walk for extended periods of time
• Ability to work in a fast-paced and often high-stress environment as well as the ability to adapt quickly to workload changes
• Ability to deal with inside and outside clientele a diplomatic and courteous manner while assuring adherence to One Health policies/procedures
• Ability to remain calm and cheerful under stressful working conditions