Job Overview
We are seeking a dynamic and highly detail-oriented Billing Manager to lead our billing operations and assure uninterrupted cash flow to the Clinic by providing support in the area of patient account billing, submission of third party reimbursement requests, and collection of balances due from third party payers and patients. The Billing Manager manages the monthly payment reconciliation process and is responsible for closing financial centers. Maintains responsibility for oversight of timely and accurate pre- insurance verification and patient/insurance revenue cycle. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment. In this pivotal role, you will oversee the entire patient billing cycle, coordinate with various departments, and maintain compliance with financial regulations and internal controls. Your expertise will drive efficiency, improve cash flow, and uphold the highest standards of financial accuracy. This position offers an exciting opportunity to influence our financial health while working within a collaborative and fast-paced environment.
EDUCATION, TRAINING AND EXPERIENCE: (INCLUDES LICENSES OR CERTIFICATIONS)
- Associate’s degree required. Bachelor’s Degree preferred.
- Successful completion of Billing/Coding training program required.
- CPC certification required.
- 5 years of responsible billing experience in a high-volume primary care clinic setting.
- Pediatric experience preferred.
- 2 years minimum experience in employee supervision.
KNOWLEDGE, SKILLS AND ABILITIES:
- Requires knowledge of medical office procedures and policies, strong interpersonal communication and organizational skills.
- Requires competence with Microsoft Office Suite (especially Excel) and strong computer skills
- Medical terminology, patient-care diagnostic/procedure/HCPCS codes and insurance knowledge (Commercial/Medicaid/Healthshare policies) required.
- Knowledge of electronic billing, third-party billing, payment posting (manual and electronic) and related procedures and methods associated with a medical office.
- Solid understanding of Accounts Receivable Process.
- Experience with Practice Management software (Aprima, Trimed, EPIC, etc).
- Strong organizational skills combined with high level of attention to detail; ability to handle multiple priorities in a fast-paced environment.
- Excellent data entry skills with high accuracy in 10 key typing; ability to analyze Excel spreadsheets using formulas for data analysis.
- Experience managing accounts receivable and collections accounts with a focus on client communication and customer service excellence.
- Requires ability to effectively supervise and manage direct reports.
- Requires ability to work independently, set personal and department level goals to achieve broader clinic goals and initiatives.
Responsibilities
- Know and understand the state and federal laws, regulations and guidelines pertaining to medical billing and collections.
- Understand proper ICD and CPT coding for diagnoses and procedures used in the office for maximum legal reimbursement.
- Make sure the Clinic maintains copies of current ICD, CPT and HCPCS code books.
- Review documentation, diagnosis and treatment information submitted by physicians, for correct coding and payer policy adherence. Document and update information on patient accounts as needed and provide feedback to physicians regarding coding and billing changes.
- Monitor changes to billing system and make adjustments to prevent claim delays.
- Maintain billing records and accounting. Individual insurance claim and patient statement activity and progress are to be current on a daily basis. Deposit of money collected, total collections by type, percent of insurance collectable and percent of collections are to be current on a weekly basis.
- Maintain credit card on file policy, following up with patients who have high balances to arrange payment.
- Keep track of no call no show appointments and send appropriate notices to patients.
- Develops and maintains departmental billing and accounts receivable procedures which comply with Federal and state regulations, and third party payer requirements.
- Reviews patient information, diagnosis and treatment information, and codes in database for correct coding and payer policy adherence. Documents and updates information on patient accounts as needed.
- Utilizes payer websites to review eligibility and patient benefits. Knowledge of Insurance plan website navigation for payment policies and appeals.
- Enters complete financial transactions in the form of third party reimbursements and personal payments to patient accounts. Assures that all account adjustments balance with amounts received. Verifies that the correct patient and payer are billed for care and treatment given. Patient and payer information must be accurate to assure collection of payments or reimbursement.
- Prepares special billings for specific payers or private pay customers.
- Submit claims to insurance company within two working days from date of service.
- Follow up on all incomplete claims or bills within thirty days from date of service.
- Submit all additional information required by insurance within thirty days from date of service.
- Send statement of any patient responsible amounts one month after date of service and each month thereafter.
- Assures timely collection of receivables. Establishes and monitors payment plans. Completes follow up on delinquent receivables every 30 days. Identifies insurance payment issues and works to resolve promptly. Ability to recognize trends.
- Post refund requests and payments that come via paper checks to accounts.
- Answers questions from other department staff regarding billing, insurance, patient accounts, etc.
- Identify billing problems, develop solutions for the problems and present the problem and solutions to Clinic Administrator. Make suggestions for improvement of billing and any other office procedures.
- Primary liaison between collection agency and physicians.
- Manages month end procedures and processes. Responsible for balancing posted payment in bank account with posted payments received in PM system.
- Oversees special projects within billing department or clinic wide as needed. Runs reports and maintains the Practice Management set up of Procedure and Diagnosis codes, as well as Insurance plans.
- Supervises billing department staff, including day today task supervision and direction, coaching and performance reviews, and disciplinary action where required. Meets regularly with direct reports to review work progress, challenges and wins.
- Know and understand the provisions of contracts clinic has entered into with insurance companies and outside billing/collection services. Ensure correct reimbursement and application. Interprets contracts for other staff where appropriate.
- Participate in contract negotiation preparations and provide input that may contribute to contract decisions.
- Meets regularly with clinic administrator to review revenue cycle and discuss department progress and efficiency.
- Reviews information and updates from insurance companies regularly and communicates important changes to key staff.
- Sets goals and works toward department and clinic wide key financial indicators.
- Other duties as assigned by administrator or physician owners.
Pay: $70,000.00 - $85,000.00 per year
Benefits:
- 401(k)
- AD&D insurance
- Dental insurance
- Health insurance
- Life insurance
- Paid sick time
- Paid time off
- Professional development assistance
- Profit sharing
- Retirement plan
- Vision insurance
Work Location: In person
