Manages the policies, objectives, and initiatives of the organization’s revenue cycle activities to achieve operational goals and cash flow targets. Implements processes and procedures to optimize the revenue cycle and ensure compliance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Establish and monitor systems for collection of claims data, processing claims and reporting functions related to fee for service billing.
- Recruits, trains, and supervises billing staff.
- Ensures that collections are maximized.
- Functions as liaison to the provider relations department of the payors.
- Serves as liaison to Practice Management application vendors around claims processing and financial reporting.
- Works with the finance department to ensure accurate and relevant reporting.
- Collaborates with AVP of Finance around issues related to revenue reports and claims processing for annual audit.
- Manage Agency EIM/ESM Virtual Gateway.
- In conjunction with IT staff, manage PM Software maintenance and upgrades.
- Complete and maintain documentation as required by l applicable funding or regulatory agencies.
- Maintain compliance with all policies and procedures.
- Ensure billing compliance with relevant MA and Rhode Island state regulations including Medicaid, with federal Medicare regulations as well as requirements of insurers.
- Participate in professional development activities and training necessary to maintain and enhance skills.
- Other duties as assigned.
- Assists with the screening of candidates for “fit” and recommends candidates for hire.
- Accountable for mentoring new employees, and ensuring they receive appropriate training for their role. Outlines clear professional development goals.
- Completes thoughtful & timely performance reviews & competencies. Retains talented staff and minimizes turnover.
- Consistently monitors and provides feedback on staff performance. Addresses concerns, develops PIPs to include retraining; ensures staff is supported and held accountable; recognizes good performance, memorializes/documents meetings.
- Ensures P&Ps (agency and department) are consistently applied.
- Timely completes all trainings, certifications, re-credentialing and licensing renewals requirements.
LEADERSHIP RESPONSIBILITY
Director: Execute the plans of the executive level and direct first-line managers and other employees. They are the connection between the executive level and everyone else. This level will provide supervision to department(s), establish procedures, and performance standards, interpret policies, and ensure employees understand the overall goals to be achieved. They will guide first-line managers with advice and in completing performance evaluations. Will develop P&P for the area of responsibility; will be the individual who is responsible for compliance, meeting all regulatory requirements, and meeting financials (revenue and budget) for their area. Moderate to a high degree of flexibility. Ex. Director, Manager.
DEGREE OF SUPERVISION
Develops Objectives: Independent judgment is required in the making of important decisions in matters where little guidance is received from the supervisor or previously established P&P.
QUALIFICATIONS
EDUCATION: BA, MA preferred
WORK EXPERIENCE: 5+ years providing oversight of billing functions in a healthcare environment
LICENSING: None
CERTIFICATION(S): CPC preferred
KNOWLEDGE:
- Proficiency in medical billing codes (CPT, ICD-10, HCPCS)
- Knowledge of Microsoft Excel and other Microsoft applications.
- Knowledge of third-party requirements, Medicare/Medicaid regulations, and electronic filing
- Thorough knowledge of medical and physician billing
SKILLS & ABILITIES:
- Strong organizational skills and attention to detail
- Excellent communication, leadership, and critical thinking skills
- Maintains strict confidentiality adhering to all HIPAA & 42 CFR regulations