Job Description

Job Description

Job Description

Description:

Job summary:

• Supervisor position responsible for directing and coordination the overall functions of the physician clinics 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.
• Professional requirements:
• Adheres to dress code standards.
• Completes annual educational requirement.
• Maintains regulatory requirements, including all state, federal, CMS and RHC regulations.
• Maintains and ensures patient confidentiality at all times.
• Reports to work on time and as scheduled.
• Wears identification while on duty.
• Attends annual Hospital Review and Department in-services as scheduled.
• Actively participates in the Clinics’ continuous Quality Improvement activities, attend committee and management meetings, as appropriate.
• Ability to work with Providers in a collaborative manner.
• Ensures confidentiality of patient’s records.
• Communicates the mission, ethics and goals of the organization, adhered to the Standards of Performance.
• Represents the organization in a positive and professional manner.
• Ensures compliance with policies and procedures regarding department operations, fire, safety, and infection control.

Essential Job Functions / Competencies:

• Oversees the operations of the billing office, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
• Severs as the practice expert and go to person for all coding and billing processes.
• Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collections.
• Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues.
• Follow up on claims using various systems.
• Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings.
• Prepares and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts in concert with the Practice Manager. Collects and compiles accurate statistical reports.
• Audits current procedures to monitor and improve efficiency of billing and collections operations.
• 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 including HIPAA compliance.
• Assists with Physician Enrollment as needed.
• 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, 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.
• Performs other miscellaneous job-related duties as assigned.
• Strive to achieve Organizational and Department goals.
• Participates in the development and implementation of operating policies and procedures for the billing office.
• Understands and remains updated with current coding and billing regulations and compliance requirements.

Regulatory Requirements:

• High School graduate with some college courses preferred.
• Five or more years of previous medical billing experience in all aspects of billing office functions.
• 2+ year management experience required.
• Knowledge of State survey regulations.

Skills:

• Detail oriented and tolerant of frequent interruptions and distractions from patients and staff.
• Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
• Skill in developing, implementing, and administering work processes.
• Proficient in Microsoft office, including Outlook, Word, and Excel.

Knowledge:

• Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of Kansas and Federal payer regulations.
• Working knowledge of CPT and ICD 10 Codes, HCFA 1500, UP04 claim forms, 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 negotiations skills, including the tact required for securing payment or discussing patient’s finances, and enjoy working in a health care setting.

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