Medical Billing and Coding Manager

Job Summary:

The Billing and Coding Manager is responsible for day-to-day operations and overseeing all medical billing, coding, and revenue cycle management operations for a busy primary care practice. This role ensures accurate coding, timely claims submission, payment posting, denial management, accounts receivable management, and compliance with federal, state, and payer regulations. In addition to managing their team, they will regularly collaborate with clinical and administrative teams, and work to optimize the financial performance of the practice.

They are responsible for optimizing the revenue cycle process, from the patient registration to final payment collection. The Billing and Coding Manager plays a critical role in optimizing processes, ensuring compliance with regulations, and improving overall efficiency. This role is crucial for ensuring the financial health and sustainability of the practice. They will assist in the continuous quality improvement and organizational excellence of the practice. The Billing and Coding Manager directly supervises a professional team of medical Billers and Coders and ensures the right resources are available to the team. They are responsible for the timely preparation and filing of insurance claims (paper and electronic claims transmission) and active management of insurance aging reports. Additional responsibilities include the timely review and follow-up on all claims and collection of insurance claims and patient accounts. In addition, they will play an active role in the coding process for medical claims and provider credentialing. They will manage staff recruitment, performance feedback, staffing schedules/assignments, time, and attendance as well as any other necessary HR support items. They will provide ongoing mentoring to develop assigned staff, in close collaboration with the Chief Executive Officer, Chief Operations Officer, and physician partners. The Billing and Coding Manager collaborates with the CEO/COO on ongoing education across both teams.

Supervisory Responsibilities:

Supervise and lead the billing and coding team, providing training, support, and performance evaluations.

• Manage recruitment, reference checks, extending offers orientation, training of new Billers and Coders to ensure the highest level of revenue cycle knowledge and support.
• Manage internal and external job postings, i.e. really, and PCWNY website.
• Actively support Open House/recruitment events.
• Maintains knowledge of Progressive Discipline, Performance Appraisals, and Termination Process and documentation via PEO. Partner with COO and Alcott HR services on performance issues.
• Maintains onsite individual staff files (in addition to PEO's staffing files) with proper documentation.
• Completes staff schedules for staff to ensure coverage for the practice.
• Manage and track time and attendance for payroll submission, approves overtime utilization within established budget.
• Accepts/manages call offs for shifts from staff.
• Meets ongoing revenue cycle requirements by developing and communicating daily staff assignments, following up on completion of tasks, providing re-education and coaching to staff, as needed.
• Provide coaching, mentoring and oversight of operational areas of accountability.
• Prepares and facilitates team meetings and cross functional meetings in close collaboration with the management team.
• Maintains up-to-date training documents, competencies, and policy/procedure manuals for the department in conjunction with CEO/COO.
• Maintains records of educational opportunities and develops individual development plans with each direct report.
• Maintains HIPAA, OSHA, and OIG standards, arranging staff training in these areas as required.
• Maintains policies and procedures and adherence to the employee manual across direct reports.
• Ensures the policies of the PCWNY Employee Handbook are being upheld.
• Provides managerial support beyond routine business hours as required for ad hoc meetings (adverse weather response) and staff call ins.
• Maintain personal cell phone availability during designated work hours.

Essential Functions/Responsibilities of the Position:

• Revenue Cycle Oversight: Manage and coordinate all phases of the revenue cycle, including patient registration, insurance verification, billing, coding, claims submission, payment posting, and collections.
• Team Leadership: Supervise and mentor revenue cycle staff, including billing specialists, medical coders, and accounts receivable personnel, ensuring high performance and professional development.
• Coding/Billing: Oversee the accurate assignment of CPT, ICD-10, and HCPCS codes based on medical documentation. Collaborate with providers to ensure proper documentation and coding practices. Ensure timely and accurate submission of insurance claims (electronic and paper). Monitor accounts receivable and manage claim denials, rejections, and appeals.
• Process Optimization: Identify inefficiencies in the revenue cycle process and implement improvements to enhance accuracy, reduce denials, and shorten the payment cycle. Work with EHR and practice management systems to streamline workflow and optimize billing processes.
• Compliance Management: Ensure compliance with all federal, state, and payer-specific regulations, including HIPAA, Medicare/Medicaid guidelines, and other relevant policies.
• Financial Reporting: Generate and analyze financial reports related to the revenue cycle, including accounts receivable, cash flow, and collection rates. Provide regular updates to CEO, COO, and physician partners.
• Denials Management: Oversee the management of denied claims, ensuring timely appeal processes and resolution to minimize revenue loss.
• Patient Financial Services: Oversee patient billing and collections processes, ensuring clear communication with patients regarding their financial responsibilities.
• Consultant/Vendor/Payor/ACO Relations: Manage relationships, communicate and engage with third-party vendors, such as collection agencies, billing software providers, and clearinghouses, ensuring quality service and cost-effectiveness. Function as liaison with insurance companies, auditors, and third-party vendors.
• Quality Initiatives: Manage relationships, communicate and engage with Quality Program partners to ensure proper reporting/revenue capture
• Technology Utilization: Ensure effective use of electronic health records (EHR) and billing software, working with IT to address any system issues or improvement needs.
• Strategic Planning: Participate in the development of strategies to improve the revenue cycle, align with organizational goals, and respond to changes in the healthcare industry.
• Budget Management: Develop and manage the revenue cycle department’s budget, ensuring resources are allocated effectively and costs are controlled.
• Policy/Procedure Changes: Obtain, Review and Communicate/Disseminate information about Insurance, Billing and Coding changes in policies and procedures. Maintain up-to-date knowledge of insurance guidelines, reimbursement trends, and coding updates. Implement policies and procedures to ensure compliance with HIPAA, Medicare, Medicaid, and commercial payer regulations.
• Reporting: Prepare and share needed reports on set cadence determined by CEO, COO, and practice partners. Examples include collections, denials, productivity, and billing trends.

Maintains proficiency with duties outlined in this job description, including, but not limited to:

• Demonstrate an in-depth understanding of the principles of revenue cycle management.
• Actively participate and report status updates on all initiatives to the Q&U meeting and other meetings as requested.
• Monitors key performance metrics throughout the day and keeps the CEO informed of any recommendations to address/adjust for any concerns or discrepancies.
• Complete monthly audits to ensure financial reimbursement captured.
• Actively contribute to presentations/education, researching appropriate topics as indicated for department meetings as scheduled.
• Actively contributes to an organization wide culture of continuous improvement.
• Other duties and/or projects as assigned by the Chief Executive Officer, Chief Operating Officer, or physician partners.
• Attend meetings, committee meetings and offsite meetings as assigned.
• Address any financial gaps (earned vs. received) with the appropriate health plan team.
• Track quality measures to assure practice compliance.
• Maintain knowledge and understanding of PCWNY Quality Initiatives and current incentive opportunities across payers and programs and increase awareness across the practice amongst providers to increase buy-in of individual & practice success.
• Regularly meet with Finance Director to audit and ensure all quality dollars are captured/reconciled (actual vs. expected opportunities), and financial targets are met.
• Monitors key performance quality metrics/payments throughout the year via a score card and keeps the CEO, COO and CMO informed of status including successes and/or issues.
• Maintain knowledge of NCQA PCMH, ACO, and QI.
• Maintain HIPAA, OSHA, OIG, and NYS DOH standards/regulations.
• Participate as an active Coder and/or Biller as needed to ensure timely claim submission

Position Qualifications:

EDUCATION: Associate's degree required; Bachelor’s degree preferred.

• EXPERIENCE (Years): Minimum 3–5 years of experience in medical billing and coding, with at least 1–2 years in a leadership role.
• CERTIFICATION, PROFESSIONAL LICENSE, DRIVERS LICENSE: Certification in medical billing/coding (e.g., CPC, CCS) required.
• SKILLS:
• Strong leadership and team management skills
• Proficiency in ICD-10, CPT, and HCPCS coding systems
• Strong knowledge of medical terminology, coding systems (CPT, ICD-10, HCPCS), and payer requirements.
• Strong knowledge of medical terminology, anatomy, and physiology
• Attention to detail in all aspects of role including, but not limited to, accuracy in coding work.
• Strong communication skills for interaction with healthcare providers, vendors, and staff
• Knowledge of HIPAA regulations and maintaining patient confidentiality
• In-depth knowledge of the entire revenue cycle process
• Strong interpersonal skills
• Professional verbal and written communication skills
• Excellent analytical and problem-solving abilities
• Proficiency in using EHR systems, billing software, and financial reporting tools
• Ability to manage multiple priorities in a fast-paced environment
• Demonstrates accountability and integrity
• Demonstrated ability to represent the practice with health plans, vendors, ACO, IPA, and accreditation organizations
• Must be self-motivated and demonstrate professionalism under adverse circumstances
• Highly organized with very effective time management skills
• Ability to multi-task, respond to rapid change, organize, prioritize, and perform work with minimal supervision
• EHR knowledge and reporting experience required
• Microsoft Office experience required
• Medent EHR software knowledge preferred

Work Environment:

• Full-time, in-office.
• The role may involve occasional travel for site visits, conferences, or meetings with external vendors.
• Regular interaction with senior management, healthcare providers, and revenue cycle staff is required.

Job Type: Full-time

Pay: $70,000.00 - $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to Commute:

• Williamsville, NY 14221 (Preferred)

Ability to Relocate:

• Williamsville, NY 14221: Relocate before starting work (Preferred)

Work Location: In person

Salary : $70,000 - $80,000