Medical Billing Manager

Location:  Port Charlotte which is about 40 min north of Fort Myers or 30 minutes south of Sarasota, Florida, US

Department: Billing/Coding Operations

Supervisor: Practice Administrator

Supervisory Responsibilities: Daily supervision over twenty Medical Billing/Coding staff members.

FLSA Status:  Exempt. Salaried management position.

General Summary

Management position responsible for directing and coordinating the overall functions of the medical billing and coding office to ensure maximization of cash flow while improving patient, physician, and other customer relations. Requires strong managerial, leadership, and business office skills, including critical thinking and the ability to produce and present detailed billing activity reports.

 
Essential Job Responsibilities
1. Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
2. Serves as the practice expert and go to person for all coding and billing processes.
3. Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection.
4. Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues.
5. Follow up on claims using various systems.
6. Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings.
7. Prepares and analyzes accounts receivable reports, weekly and monthly reports, and insurance contracts in conjunction with the Practice Administrator. Collects and compiles accurate statistical reports.
8. Audits current procedures to monitor and improve efficiency of billing and collections operations.
9. Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
10. Participates in the development and implementation of operating policies and procedures.
11. Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
12. Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures.
13. Keep up to date with carrier rule changes and distribute the information within the practice.
14. Performs physician credentialing actions.
15. Understands and remains updated with current coding and billing regulations and compliance requirements.
16. Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
17. Maintains library of information/tools related to documentation guidelines and coding.
18. Supervises billing office personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
19. Provides, oversees, and/or coordinates the provision of training for new and existing billing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
20. Coordinates team member time off in a manner that does not negatively impact necessary daily functions.
21. Performs other miscellaneous job-related duties as assigned.

 
Education
- Associates degree, preferably in business administration or related field.
- Bachelor's Degree preferred.
- Certified coder.
- Certified Compliance Officer a plus.
- Knowledge of Advanced Data Systems Software platform a plus.

 Experience
- Minimum of five (5) years Medical Insurance/Healthcare Billing and Collections experience in a      medical practice or health system, with a deep understanding of medical billing rules and regulations.
- Two (2) years supervisory or management experience preferred.
- A combination of education and experience will be considered.

 
Other Requirements - Prior experience with an electronic medical record system required.

Knowledge
- Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of Florida and Federal payer regulations.
- Working knowledge of CPT and ICD9 codes, HCFA 1500, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
- Knowledge of business management and basic accounting principles to direct the billing and coding office.
- Sufficient knowledge of policies and procedures to accurately answer questions from internal and external customers.
- Possess excellent negotiation skills, including the tact required for securing payment or discussing patient's finances, and enjoy working in a health care setting.
- Up to date with health information technologies and applications.

Skills
- Skilled in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
- Skilled in developing, implementing, and administering work processes.
- Detail oriented and tolerant of frequent interruptions and distractions from patients and staff.
- Effectively communicate with physicians, patients, insurers, colleagues and staff.
- Proficient in Microsoft Office, including Outlook, Word, and Excel.

Abilities
- Ability to work under minimum supervision and demonstrate strong initiative.
- Ability to supervise and train employees, to include organizing, prioritizing and scheduling work assignments to meet practice timelines.
- Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
- Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding AR, billing and other office duties.
- Ability to recognize, evaluate, solve problems, and correct errors, and to develop processes that eliminate redundancy.
- Ability to conceptualize work flow, develop plans, and implement appropriate actions.
- Ability to communicate effectively in writing, over the telephone, and in person.

 
Equipment Operated
Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

 
Work Environment
Position is in a well-lighted office environment. Occasional evening and weekend work may be required.

 
Mental/Physical Requirements

Daily activity is 80 percent sitting and 20 percent walking or standing.

 
BILLING/CODING OFFICE RECURRING TASKS AND PROJECTS
Task Due
Billing Office Inquires (In Office and by Phone) - Daily
Check/Fix Electronic Claim Submissions Rejections - Daily
Daily Posting Validation - Daily
Load New/Updated Patient Insurance Information - Daily
Obtain Pre-Authorizations for Tests and Procedures - Daily
Post Insurance Payments (Electronic) - Daily
Post Insurance Payments (Mail) - Daily
Post Office Visits and Tests - Daily
Post Patient Payments (Mail) - Daily
Post Patient Payments (Office, incl. collections) - Daily
Upload and Transmit Claims - Daily
Work Insurance Denials - Daily
Create Insurance Aging Report - Weekly
Export Billing Statements to EDI Vendor - Weekly
Process Insurance Refunds - Weekly
Process Patient Refunds - Weekly
Verify Successful Billing Statement Export - Weekly
Work Insurance Aging Report - Weekly
Create Pre-Collections Work List to Annotate “HOLD” Accounts - Monthly
Manage Physician Licensure and Credentialing - PRN
Manage Practice Fee Schedule - PRN
Meaningful Use Project - PRN
PQRS Project Management - PRN
Print Secondary Insurance HCFA Forms - PRN