Billing Manager

at Katahdin Valley Health Center in Dover Foxcroft, Maine, United States

Job Description

Katahdin Valley Health Center
Job Description
Billing Manager

Reports To: Chief Financial Officer
Status: Salaried Exempt
Facility Location: Varies
Hours: Monday-Friday 8:00AM-5:00 PM

POSITION SUMMARY
The Billing Manager is responsible for directing and coordinating the overall functions of the Billing Department to ensure maximization of cash flow while improving patient, provider, 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.

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. Operates within the guidelines set forth as outlined in the finance policy manual.
3. Liaison between Billing, Practice Managers, Nursing Manager and Administrative Team for disseminating information between all parties.
4. Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection.
5. Analyze billing and claims for accuracy and completeness; Oversee Claim Submission to proper insurance entities and follow up on any issues.
6. Maintains contact with other departments to obtain and analyze additional patient information to document and process billings.
7. Prepared and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts in concert with the Practice Administrator. Collects and compiles accurate statistical reports.
8. Audits current procedures to monitor and improve efficiency of billing and collections operations in conjunction with the Chief Financial Officer and Chief Executive Officer.
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 protocols.
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, collections and accounts receivable to take appropriate action to realign staff and revise policies and procedures.
13. Ensures coding is accurate and providers receive regular training in conjunction with Billing Director.
14. Keep up to date with carrier rule changes and distribute the information within the practice.

15. Responsible for all physician credentialing actions in conjunction with Billing Director.
16. Understands and remains updated with current coding and billing regulations and compliance requirements.
17. Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
18. Coordinate the daily operations and oversee employees within the Health Records Referral, and Patient Assistance Departments. Is responsible for their direct reports, hiring, annual reviews, scheduling and payroll.
19. Oversite of the following: incoming referral telephone calls, referral requests within EHR. Scheduling of appointments with specialist or testing sites. EHR being sent to specialist, testing site and insurance company. Referral follow-up appointments for patients. Reports/Results follow up.
20. Monitor changes in laws and regulations that affect health information management, including assuring compliance with health information technology compliance regulations.
21. Provide orientation and on-going training to the Health Records, Referral, and Patient Assistance Departments employees.
22. Maintains library of information/tools related to documentation guidelines and coding.
23. 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; provides oversight for new and existing billing staff on applicable operating policies, protocols, systems and procedures.
24. Coordinates team member time off in a manner that does not negatively impact necessary daily functions.
25. Participates in the Care Team as outlined in KVHC protocols.
26. Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection.
27. Maintains up to date systems and implements changes as third party insurance changes occur.
28. Maintains systems of checks and balances of encounters to verify maximization of charges.
29. Maintains systems of checks and balances of EOB’s to verify maximization of revenue.
30. Completes chart/coding audits annually
31. Performs additional duties or projects as assigned by the Billing Director.
32. Adheres to all KVHC policies and protocols.
33. Complies with all safety rules and protocols. Reports all incidents, regardless of severity, immediately to their supervisor and completes an incident report and investigation form, which will be forwarded to Human Resources within 24 hours of the incident.
34. Conducts themselves as a good steward in the communities served by KVHC; represents the organization at outreach activities as needed.
35. Actively participates as committee member as assigned by the Chief Executive Officer.
36. Interacts harmoniously and effectively with others. Focusing on the attainment of organization goals and objectives through a commitment to team work.
37. Conforms to acceptable attendance and punctuality standards as expressed in the employee handbook.
38. Abides by the organization’s compliance program and requirements
39. At times you may be faced with challenges that may impact patient care. Addressing these challenges may not be in your job description, however Katahdin Valley Health Center encourages each team member to go above and beyond to address the patients’ needs in the moment. Employees have the autonomy to see the care experience through from A to Z to show our patients KVHC C.A.R.E.S.

40. The employee may be responsible for traveling to multiple locations as specified in their job offer and/or contract.

PROFESSIONAL EXPECTATIONS
1. Admit mistakes or missteps openly, own your own behavior, forgive one another, and model vulnerability and humility.
2. Keep discussions about team members, subordinates, and colleagues as well as challenges in the workplace, positive, constructive, and factual.
3. Be mindful of employee confidentiality even among peers, and particularly where an issue involves a peer.
4. Only say what you would be willing to say to someone directly.
5. Whenever possible, speak directly to the person with whom you are having a disagreement or a challenge. Challenge yourself to engage in these discussions. Do not avoid constructive conflict.
6. Work with your supervisor or HR when you need to process a performance or behavioral situation with a colleague or subordinate to determine next steps.
7. It is always okay, and usually preferable, to pause, and take time to reflect before reacting to a situation.

EDUCATION AND EXPERIENCE
1. Associates Degree in Business Administration or related field, Bachelor’s Degree preferred;
2. Certified as a Professional Coder.
3. Experience with Provider Credentialing preferred
4. Experience with Medical Insurance/healthcare Billing and collections with a deep understanding of medical billing rules and regulations
5. Two years supervisory or management experience preferred
6. Prior experience with electronic medical record system required
7. Thorough understanding of medical billing, collections and payment positing, revenue cycle, third party payers, Medicare, strong knowledge of Maine and Federal payer regulations.
8. Working knowledge of CPT and ICD10 codes, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
9. Knowledge of business management and basic accounting principles to direct the billing and coding office.
10. Sufficient knowledge of policies and procedures to accurately answer questions from internal and external customers.
11. Possess excellent negotiation skills, including the tact required for securing payment or discussing patient’s finances, and enjoy working in a health care setting.
12. Up to date with health information technologies and applications.
13. Proficient in Microsoft Office, including Outlook, Word, and Excel.
14. Must be able to work independently in a team setting and to react to change productively.
15. Must have excellent interpersonal skills and problem solving skills.
16. Must be able to work under pressure in a busy health office setting.
17. Must possess a clean criminal and DHHS background.
18. Must possess the ability and means to travel between clinics as needed.
19. Valid State of Maine Driver’s license and ability to be insured by KVHC’s vehicle insurance carrier.

FUNCTION, DEMANDS AND PHYSICAL PERFORMANCE
Requires full range of body motion with the ability to bend, kneel and stoop. Must possess: the ability to sit and or stand for long periods of time, the ability to lift approximately 30 lbs., visual acuity with color vision, the ability to communicate effectively and calmly in a professional manner, the ability to follow all workplace policies including safety and confidentiality, the ability to perform repetitive motion keyboarding functions, exposure to communicable disease, toxic substances, medicinal preparations and other conditions common to clinic environment. Knowledge of organizational policies, regulations, and procedures to administer patient care. Must possess the ability to work with and around medical equipment and instruments safely and effectively as appropriate. Knowledge of common safety hazards and precautions to establish a safe work environment including Safety Data Sheets. Skill in preparing and maintaining records, writing reports, and responding to correspondence. Skill in developing and maintaining department quality assurance. Skill in establishing and maintaining effective working relationships with patients, medical staff, and the public. Ability to maintain quality control standards. Ability to react calmly and effectively in emergencies. Ability to interpret, adapt and apply guidelines and procedures. Ability to communicate clearly.

CONFIDENTIALITY OF PATIENT INFORMATION AND ALL KVHC HEALTH CENTER BUSINESS IS ESSENTIAL. EMPLOYEES MUST COMPLY WITH THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996-PUBLIC LAW 104-191