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About the role
- Oversee the operations of the billing department including medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
- Serve as the practice expert and go-to person for all coding and billing processes.
- Plan and direct patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection.
- Ensure billing activities follow Federal, State, and payer regulations, guidelines, and requirements.
- Spearhead payor projects and resolve complex billing issues, discrepancies, and claim denials.
- Review and interpret operational data to assess need for procedural revisions and enhancements; participate in design and implementation of systems to enhance revenue and operating efficiency.
- Maintain contacts with other departments to obtain and analyze additional patient information for billing.
- Follow up on claims using practice management and clearinghouse systems.
- Provide, oversee, and coordinate training for new and existing billing staff on policies, systems, and procedures.
- Develop and implement standard operating policies and procedures.
- Supervise billing office personnel, including work allocation, training, and performance management.
- Coordinate team member time off to avoid negative impact on daily functions.
- Prepare, analyze and present accounts receivable reports and daily, weekly, and monthly financial reports; monitor KPIs, SLAs, month-to-date targets, and productivity.
- Audit procedures to monitor and improve efficiency of billing and collections operations; analyze trends impacting charges, coding, collection, and accounts receivable and take corrective action.
- Keep up to date with carrier rule changes and distribute information within the practice; perform physician credentialing actions.
- Maintain library of information/tools related to documentation guidelines and coding.
Requirements
- Associates degree, preferably in business administration or related field; bachelor’s degree preferred.
- 7+ years of medical insurance/healthcare revenue cycle experience will be considered in lieu of the degree.
- Minimum of 3 years medical insurance/healthcare billing and collections experience in a medical practice or health system.
- Physical therapy experience preferred.
- Two years’ supervisory or management experience preferred.
- Medical coding/industry-related certification a plus.
- Experience working in Cerner, eClinicalWorks, and/or Athena a plus.
- Strong communication, negotiation, and interpersonal skills.
- Ability to work independently and as part of a collaborative team.
- Exceptional problem-solving abilities and attention to detail.
- Advanced proficiency in RCM software and Microsoft Office Suite, data analytics, and process improvement initiatives.
- Ability to adapt to changes in regulations, technologies, and industry trends.
- Ability to monitor team performance and make adjustments as needed.
- Must be on site for the first 3-6 months.
Benefits
- WFH Flexible
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