Billing, Claims & PAG Associate Manager

Job Summary

The supervisor's overall role is to communicate organizational needs, oversee employees' performance, provide guidance, support, identify development needs, and manage the reciprocal relationship between staff and the organization so that each is successful

The Billing, Claims & Patient Advocacy Group (PAG) Assoc. Manager’s primary objective is to manage the billing and coding, processes ensuring accurate and timely coding and filing of claims. Oversee the Accounts Receivable team, ensuring the cash posting process is posted timely and accurately, including all other job functions. As well as managing the PAG team ensuring they work with patients, in conjunction with the sales team, to navigate the patients through their insurance benefits, self-pay arrangements and co-insurance while complying with EBI corporate policies.  

Oversee the preparation of invoices to both Doctor’s offices, hospitals and third-party payers. 

Reviews work of billing, coding, and cash posting staff to ensure accuracy, resolving inconsistencies and providing training as needed. 

Maintains staff by recruiting, selecting, orienting, and training employees and developing personal growth opportunities. Focus on corporate targets & growth, provide daily dashboards reports & continuously evaluate streamline processes & transactions, when applicable.  

Principal Duties and Responsibilities

1. Manage & oversee all billing workloads ensuring timeliness of claim submissions.
2. Establish & monitor all EDI clearinghouses services & connections to ensure all claims are processed timely.
3. Ensure all coding is processed timely and accurately
4. Complete & maintain EFT/ERA enrollments
5. Maintain payer billing requirements and update payer & billing databases
6. Oversee billing, accounts receivable & patient advocate performance & accuracy
7. Complete & analyze all department dashboard reports for inconsistencies & to reach targets.
8. Create strategies to optimize billing, coding and PAG processes
9. Collaborate with other departments to ensure efficient & strategic practices
10. Handle Implantable invoicing, collections and establish electronic payment process with hospitals.
11. Demonstrates excellent customer service skills, strong written and verbal communication as well as possessing a professional telephone manner.
12. Conduct regularly scheduled audits on calls for improvement and training
13. Develop and facilitate all training activities & processes
14. Ensure all individuals comply with corporate policies. 
15. Conduct quarterly feedback sessions with team members including yearly performance evaluations
16. Other job functions as determined necessary and as assigned by management.

This is not an exhaustive list of duties or functions and may not necessarily comprise all the "essential functions" for purposes of the ADA.

Expected Areas of Competence (i.e. KSAs) 

1. Knowledge or understanding of Commercial insurance, Medicare, Medicaid, and other governmental and private insurance products.
2. Medical terminology and health insurance background required.
3. Coding experience using ICD-10 diagnosis codes, CPC certificate a plus  
4. Understanding of health insurance concepts and benefit design required.
5. Excellent customer service skills, analytical problem-solving skills, strong written and verbal communication skills, professional telephone manners and well organized.
6. Able to work with balancing the team and individual responsibilities.
7. Experience using Microsoft Office tools such as Word and Excel.
8. Ability to learn and use proprietary programs such as FileNet, A/S 400, IFM.

Education/ Experience Requirements

Associate’s degree 

2–3-year Leadership Role within an organization

Minimum of 3-5 years of Billing, Coding and medical background experience, Durable Medical Equipment preferred

Travel Requirements 

Less than 5%