The Medical Billing and Coding Manager is responsible for supervision and management of all aspects of the revenue cycle department, including claims processing, revenue monitoring and maximization, and quality improvement initiatives.

The Medical Billing and Coding Manager develops business processes and standards around medical coding, billing, collections, and encounter documentation, to ensure compliance with all applicable laws, regulations and contractual obligations, and is responsible for practice management and billing software implementation.

The salary range: $100,994.40 to $116,704.64 is commensurate with experience.

ESSENTIAL FUNCTIONS

• Manage and oversee the daily operations of the medical billing and coding function.
• Ensure billing and medical record compliance with all state and federal regulations.
• Design and manage the revenue cycle. Revenue cycle management duties will include monitoring of medical billing codes utilized by the organization, evaluate regularly to ensure maximum revenue generation while remaining in compliance with regulations.
• Review workflows for each program/client partner to ensure maximum capture of billable activities into the practice management and billing system.
• Monitor the effectiveness of billing operations and implement changes as necessary. Work with internal auditor to coordinate audit procedures to ensure accurate and timely billing services.
• Handle customer service inquiries regarding billing and resolve any issues.
• Serve as super-user and business administrator of medical practice management and billing system.
• Support system integration efforts between programs/clients and IT organization as needed.
• Review and resolve issues related to claims billing, rejections and collections.
• Develop and implement policies and procedures for coding and billing services for programs and clients of Heluna Health.
• Coordinate and monitor 835 EDI transactions in partnership with Information Technology support team and Controller.
• Regularly analyze billing and collection data in support of payor contract negotiations.
• Keep up to date with changes in coding and billing laws, regulations and industry trends. Evaluate impact to Heluna Health organization. Implement policy and procedure changes and train staff accordingly.
• Recruit, train and mentor billing staff, fostering a well-functioning and supportive team environment.
• Support health plan contracting activities as needed, analyzing reimbursement rates in comparison to market and organization data.

JOB QUALIFICATIONS

Must be proficient in practice management and billing software and MS Office Suite (including Excel, Word and Outlook). 

Competency Statements

• Leadership skills – Lead by example and as necessary with day-to-day activities and assigned projects. Be able to lead team effectively.
• Detail-oriented – Ability to pay attention to the minute details of a project or task.
• Accuracy – Ability to perform work accurately and thoroughly.
• Honesty/Integrity – Ability to be truthful and be seen as credible in the workplace. Demonstrate ability to maintain confidentiality, exercise discretion, sound judgment and professionalism in handling sensitive information.
• Accountability - Ability to accept responsibility and account for his/her actions.
• Business acumen – Ability to grasp and understand business concepts and issues.
• Financial aptitude - Ability to understand and explain medical coding, billing and collection issues in context of impact to revenue and financial statements. Ability to evaluate and make recommendations around the implementation of new workflows and procedures in the context of the organization.
• Problem solving and analytical skills – ability to strategically interpret data, assess issues and initiate solutions.
• Self-directed – able to assess workload, organize and prioritize tasks
• Timeliness - Ability to plan and complete tasks within the required timeframe
• Communication skills – Ability to clearly express oneself both orally and in writing to various levels within the organization. 
• Team player – Ability to work effectively in a team environment, within the department and across all departments.

Education/Experience 

• Proven experience as a billing manager in a healthcare setting, including experience with Medi-Cal is required.
• Bachelor's Degree in Finance, Business Administration, Health Information Management, Public Administration or other related discipline is desirable.
• Minimum ten years work experience including both management and hands on experience is required, including both medical billing and medical coding.
• Extensive knowledge of Medi-Cal policies, regulations and billing procedures.
• Experience with development of procedures and system implementation and administration.
• Solid background in HIPAA regulations, legal and compliance issues related to practice management, billing, coding, and standard of care. 
• Solid employment history with demonstrated competency and progressive increase in responsibilities.
• Experience in non-profit environment including government grants and contracts is a plus.

Certificates/Licenses/Clearances

• Coding certification is preferred. 

Other Skills, Knowledge, and Abilities

• Critical Thinking - Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to review and interpret data generated as part of regular job duties.
• Ability to meet deadlines and work under pressure.
• In-depth understanding of medical practice management, workflows, coding and billing.
• A positive, high energy, self-motivated and collaborative work style is highly desirable.
• Experience working with internal controls and internal or external audits is a plus. 

PHYSICAL DEMANDS

• Stand: Frequently
• Walk: Frequently
• Sit: Frequently
• Handling / Fingering: Occasionally
• Reach Outward: Occasionally
• Reach Above Shoulder: Occasionally
• Climb, Crawl, Kneel, Bend: Occasionally
• Lift / Carry: Occasionally - Up to 10 lbs 
• Push/Pull: Occasionally - Up to 10 lbs
• See: Constantly
• Taste/ Smell: Not Applicable

Not Applicable = Not required for essential functions

• Occasionally = (0 - 2 hrs/day)
• Frequently = (2 - 5 hrs/day)
• Constantly = (5 hrs/day)

WORK ENVIRONMENT

General Office Setting, Indoors Temperature Controlled

EEOC STATEMENT

It is the policy of Heluna Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law.