Manages the day to day supervision and processes associated with the billing department. Ensures the accurate and timely billing and collection of medical and dental claims through a well-trained, properly directed, staff and organization. 

PRIMARY ACCOUNTABILITIES

Achieve Results

Ensure timely and accurate billing and collection of medical and dental claims. Ensure that the billing and collection processes meet or exceed the organization’s financial and operational goals.

Develop and implement systems, mechanisms and controls to monitor and ensure all billing and collection efforts are functioning in the most efficient and effective manner possible. Recommend improvements to existing processes, and support ongoing improvement of the organization’s billing and collection efforts.

Ensure timely and accurate problem resolution between the organization and its patients, payor sources, as well as vendors, contractors, and other related business entities.

Monitor productivity, and manage work assignment and process improvement. Develop and implement reporting tools and mechanisms which result in the continuous awareness of the organizational financial results related to billing, collection, denials, and all related performance metrics.

Operational Excellence

Ensure the billing processes and collection mechanisms meet or exceed all requirements for internal controls as well as those from all third party payors.

Ensure all billing processes and collection functions are compliant with all internal policies as well as state, local, and federal laws, regulations, regulatory and/or best practices.

Ensure all billing and collection efforts contribute to a positive patient experience.

Relationships

Develop and ensure effective, positive relationships within and among the medical billing staff, as well as with other departments within the organization.

Develop and ensure positive working relationships with patients, contractors, vendors, third party payor resources and related entities.

Leadership & Stewardship

Uphold and consistently represent the values, mission, and policies of the organization at all times.

Ensure the organization is appropriately staffed with a full complement of billing staff. Foster a workplace that results in the development of a high performing team of professionals. Ensure that all staff members are properly coached and directed, and that clearly defined measurements of performance and rewards are utilized to enhance individual and organizational effectiveness.

PRIMARY TASKS AND DUTIES

Submit the claims to the appropriate health plans on a daily basis, review all denials for complexity, make corrections and resubmit claims within 30 days of the denial received date.

Complete claim forms, submit bills and claims, perform quality control procedures on all claim forms and detail bills to ensure accurate billing.

Contact vendors regarding denials or benefit coverage.

Verify insurance benefits.

Manage all staff members, and provide day to day supervision, training, and support

Responsible for running all billing reports and maintaining report books by funding source.

All other duties as assigned.

ESSENTIAL FUNCTIONS/KEY COMPETENCIES

Demonstrate a strong business acumen as well as substantial knowledge and expertise in medical claims and billing. Analyze, synthesize and communicate complex data, clinical information, business needs and related issues in an accurate, objective and straightforward manner.

Demonstrate a high level of problem solving skill.

Demonstrate the ability to make critical medical billing decisions supported by substantial financial analysis and critical data based decision making.

Provide day to day leadership and supervision of the medical billing staff. Effectively manage conflict and change.

Demonstrate interpersonal savvy and influence skills in all dealings with regulatory agencies, government entities, network providers, and related concerns.

Demonstrate and engage in the use and development of technology to provide information and analysis of departmental outcomes and process improvement.