Billing Manager

Job Description

Job Description

Company : Eye Specialists of Mid-Florda, PA

Position : Billing Department Team Leader

Department : Accounts Receivable and Payables

FSLA Status : Exempt

SUMMARY

The Billing Department Team Leader is responsible for the complete supervision of personnel for the billing department and the management of patient accounts. This position ensures the timely collection of insurance and patient accounts receivable. This position also entails negotiating provider agreements, establish new contractual working relationships, analyze proposed fee schedules and compare against reimbursement rates, develop reimbursement rate counteroffer for each health plan product, work with Credentialing Specialist to ensure the credentialing process is initiated and completed in a timely manner, follow up and obtain signed agreements and ensure contract information is integrated into EMR system, monitor new managed care trends, monitor health plan solvency on a quarterly basis, and oversee reimbursements are at contracted rate.

MINIMUM QUALIFICATIONS

Education and Experience

• High school diploma or GED required
• Bachelor Degree or Associate Degree in a related field preferred
• Five years of management experience in a billing, collections and medical records in ophthalmology preferred
• CPC or coding certification by the American Academy of Ophthalmology preferred
• Working knowledge of human resource law required
• Extensive knowledge of ICD-10 and CPT codes for ophthalmology & optometry required
• Knowledge of CMS, state and federal regulations and laws impacting Medicaid Managed Care
• Strong negotiation skills, with a detailed understanding of Commercial, Medicare and Medicaid reimbursement techniques, pricing and financial analyses.
• Must have Patient Financial Services / Business Office experience with Medicare, Medicaid and Commercial Insurance Billing and three years of progressive management experience in a lead or supervisory role.
• Must be a hands-on manager and leader with a focus on performance.

Essential Skills and Abilities

DUTIES AND RESPONSIBILITIES

1. Directs insurance and patient accounts payable and accounts receivable functions

a. Billing system training (All Dept. Training)

b. Charge Posting

c. Cash, adjustment, denial posting

d. Refund processing

e. Third party / patient billing

f. Third party / patient follow-up

g. Coding

h. Contractual and network oversight. To ensure maximum reimbursement payout and opportunity. In line with Medicare, Medicaid, and Commercial lines of business.

2. Ensures all charges are posted within 24 hours of the date of service.

3. Ensures all insurance claims are filed within 24 hours of the date of service.

4. Ensures all rejected claims are researched properly and corrected as needed and resubmitted within five business days.

5. Ensures the practice fee schedule is updated annually or as needed.

6. Ensures the collection of insurance and patient accounts meet or exceed the national standards for ophthalmology / Optometry.

7. Ensures the aging of accounts receivables are within the guidelines of the MGMA for ophthalmology & Optometry. Benchmarks are as follows :

Ø 0-30 days 58% - 75%

Ø 31 – 60 days 9% - 15%

Ø 61-90 days 4%-6%

Ø 91-120 days 2%-5%

Ø 120 days 4%-16%

8. Manage a full portfolio of payer contracts and relationships in assigned markets

9. Assisting contract analysts with payer contract issues related to complex payment methodology and reimbursement strategies.

10. Responsibilities include overseeing appropriate billing and collection procedures in order to maximize reimbursement.

11. Maintaining appropriate internal controls, monitoring activities of collection agencies and insurance companies.

12. Oversees the strategic, long-range planning and staffing of the billing process

a. Establish written and consistent billing policies and procedures

b. Evaluate effectiveness of the front desk processes

c. Evaluate effectiveness of the billing processes

d. Determine changes required for effective accounts receivable management

13. Human Resource Management

a. Consistently and effectively supervises all billing personnel

b. Ensures all billing personnel records are up-to-date and in compliance with federal and state laws

c. Interviews and / or hires under the direction of Human Resources

d. Coordinates and completes the new employee orientation program for billing & Insurance Verification department personnel. Include referral team members.

e. Evaluates performance and effectiveness of billing staff Insurance Verification department personnel. Include referral team members.

f. Disciplines and / or terminates under supervision of Human Resources / CEO

14. Develops and coordinates a quality assurance and compliance program.

15. Staff Training and Development

a. Participates in the development and administration of comprehensive training programs to enhance growth of the billing staff and the billing department Insurance Verification department personnel. Include referral team members.

b. Identifies and meets cross-training needs at all times