SUMMARY
Responsible for the supervision, direction and monitoring of all assigned billing staff to ensure proper and accurate claims processing as well as optimum reimbursement in a timely manner. Identifies pattern problems and resolves by working with provider representatives, third party administrators and/or staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES
include the following. Other duties may be assigned.
Responsible for personnel management to include proper training for new staff and the effective allocation of manpower to optimize claims processing and collection recovery. Responsible for insuring all charges are captured, billed correctly and coded in compliance with prevailing regulatory requirements. Assures the accurate and timely posting of payments, timely reconciliation of entries and processing of refunds.
Selects, trains, counsels and evaluates employee performance to meet RAO billing goals.
Acts as coding resource for complex exams or difficult diagnostic coding and assists with medical appeals, as necessary.
Ensures that Accounts Receivables are maintained at 90 days or less unless extenuating circumstances.
Responsible for the timely turnover (aged not more than 150 days) of delinquent accounts to the collection agency after accounts have been thoroughly worked.
Establishes policies and procedures pertaining to all aspects of the billing operations. Maintains for easy reference access by staff and for training & development of new staff.
Monitors billing and collection operations to detect pattern problems (i.e., coding rejects or incorrect allowed amount on payments) and resolves or offers suggestions for resolution. Addresses specific issues directly with payors and/or refers to CBO Operations Manager.
Keeps abreast of current regulatory changes concerning billing and collection activities to include coding updates, fee schedule updates, compliance laws, credit and collection regulations, and policy changes. Communicates changes to staff in written policy directives and through staff meetings.
Maintains costs and expenses at a minimum to ensure budgetary compliance.
SUPERVISORY RESPONSIBILITIES
Supervises approximately 12-18 billing staff.
EDUCATION and/or EXPERIENCE
High School diploma or equivalency required. Some college level coursework preferred in business or related field. Minimum five years medical insurance and billing experience. Minimum three years supervisory experience. Formal training and medical terminology and coding preferred.
