RCM Senior Billing Manager

SimonMed Imaging is one of the largest outpatient medical imaging providers and largest physician radiology practices in the United States. We specialize in using the newest diagnostic imaging technologies and bringing them to the community in an affordable and accessible way. Our logo “See Tomorrow Today” recognizes that new technology can help provide a more accurate diagnosis but needs to be readily available and affordable.

Advanced technology can be expensive but a key part of our mission is to provide it at an affordable cost. SimonMed often saves patients a significant amount in their out of pocket costs and is a national leader in providing cost transparency.

A final part of our mission is to provide care in a supportive and service oriented environment for our patients, referring providers and staff and this reflected in our comfortable office settings and well-trained, compassionate staff.

Role Description:

The Sr. Billing Manager works with Revenue Cycle Management cross-functional teams and leadership, teams across the SimonMed organization and vendor partners to optimize revenue, prioritize patient financial wellbeing, and enable teams to do their best work.

Role-Related Functions:

• Monitors incoming charge volumes on a daily basis and ensures timely billing, clean submission through the billing systems and processes. Review and present monthly charge audit summaries.
• Reviews and monitors Denial and Aging reports on a regular bi-monthly basis to ensure that any/all rejections are quickly followed up on and corrected, along with reporting any anomalies to Sr. Dir. RCM and working proactively to reduce problem areas.
• Works with credentialing team to ensure timely processing of claims, review pending items and review regular with team to ensure billing vendor is processing claims accurately and timely.
• Participate in monthly Credentialing Committee meetings and present credentialing and certification related denials for follow up.
• Participates and brings item for review to monthly payer JOC meetings.
• Works with cash/payment posting/reporting team to ensure that accounts are closed and all exceptions are handled in a timely manner.
• Assists with preparation for audits; participates in audit.
• Assists with insurance contract issues as needed.
• Ensures that new clients are implemented in a timely manner and are on-boarded successfully so that cash flow disruption is avoided.
• Evaluates and manages performance of assigned Operations Managers, Supervisors and team Leads to resolve staff and performance issues within billing operations.
• Accountable to productivity and performance SLAs for billing and A/R follow up, cash collections.
• Works with IT Applications team to ensure file maintenance is accurate and current. Routinely review and monitor reporting with billing agent to ensure accuracy of master files, including payers, denials, master fee schedules.
• Participate in Quarterly User Access review.
• Demonstrates competency in the performance of job related skills appropriate to his/her customer populations and departmental services.
• Oversees the work of special projects and evaluate internal processes to ensure company is receiving optimal reimbursement.
• Responsible for oversight and follow up for Company Accounts. Evaluate quarterly including outreach for overdue accounts to obtain payment. Report overdue accounts to Sr. Dir. RCM and VP, Marketing.
• Duties include, but are not limited to; creating and evaluating production on staff assignments, handling escalated patient inquiries, reviewing and authorizing refunds or adjustments to accounts receivables, employee training and scheduled employee reviews.
• Manage staff to identify issues, and implement plans to improve revenue.
• Development and collaboration with departments related to necessary training tips and updated policy & procedures related to RCM processes.
• Support other company wide cross functional projects as necessary.
• Duties as assigned.

DRESS ATTIRE: Business/Administrative wear.

Location: Scottsdale, AZ and/or Hybrid-Remote

MINIMUM QUALIFICATIONS: Requires a bachelor's degree in area of specialty or graduation from an accredited college, university, or comparable educational institution with a minimum of seven or more years of experience, or an equivalent combination of education, training, and experience, radiology preferred. Must have knowledge of HIPAA guidelines, experience with Microsoft Word and Advanced Excel skills, including pivot tables and setting up analysis from scratch. Research and data analysis experience and experience in end-to-end revenue cycle as well. Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers. Must be proficient in telephone etiquette. Prior experience in working with and managing off-shore resources. Possess a solid understanding of billing services processes including A/R and cash management. Excellent organization skills, multi-tasking, high-pressure environment.

Key experience

• 7 years managing revenue cycle, including account receivable follow up for all government (Medicare/Medicaid) type payers along with all Commercial and Managed Care plans.
• 5-7 years managing to key metrics (KPIs) and Service Level Agreements (SLAs), including days in AR, AR > 120 days, bad debt, on and offshore production and quality levels
• 5-7 years auditing various patient account and payer activity, in order to determine root cause
• Overall understanding of front-to-backend processes, including scheduling, registration, authorization, charge entry, coding, claims requirements and payer follow up.
• 5-7 years direct experience with payers by attending monthly meetings to follow up payer opportunities for overall provider improvements, special projects, contract review/negotiations
• 5-7 years of denial management
• 7 years experience in managing AR follow up/production staff, offshore and billing vendor management
• Outpatient radiology experience preferred. Some ancillary services have similarities, including hospital-based radiology, cardiology, pathology and emergency medicine.
• Policy & Procedure development and implementation with oversight
• Knowledge and understanding of basic MIPS program

Key skills

• 5-7 years of experience with Microsoft Excel, creating and building tables, pivot tables, and analysis in order to determine root cause, opportunities to work with payer on special projects and identifying feedback tools for problem areas causing rejections/denials
• 7 years experience working with various billing platforms, name them