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.