Responsible for overseeing the non-governmental billing process and overseeing the performance of all billers.


Principal Accountabilities:

Team Leadership & Supervision: Lead, manage, and mentor the billing department team, ensuring the efficient processing of patient accounts, claims, and payments. Conduct regular performance evaluations and provide ongoing coaching to ensure the team adheres to quality and compliance standards.

Billing Operations Oversight: Oversee the billing cycle, including the preparation, submission, and follow-up of patient insurance claims and patient billing statements. Ensure that all claims are submitted in compliance with payer-specific guidelines and healthcare regulations.

Payer Compliance & Billing Regulations: Maintain up-to-date knowledge of payer-specific requirements, billing regulations, healthcare compliance standards (e.g., HIPAA, CMS), and ICD-10, CPT, and HCPCS coding. Ensure that all claims meet payer requirements for proper reimbursement and avoid penalties for incorrect billing.

Claims Management & Denial Resolution: Manage and analyze denied, rejected, or unpaid claims. Lead efforts in the investigation and resolution of claim denials by collaborating with payers and internal teams to ensure re-submission or correction. Oversee appeals for denied claims in accordance with payer guidelines and legal requirements.

Compliance & Risk Mitigation: Ensure that all billing and coding procedures adhere to federal, state, and payer-specific regulations. Work closely with compliance officers and legal teams to mitigate financial risk and avoid potential audits or legal issues related to billing errors, fraud, or non-compliance.

Aged Accounts & Receivables Management: Monitor and manage the aging of accounts receivable (A/R) to ensure timely collections. Analyze trends, identify root causes of delays, and implement corrective actions to reduce aging balances.

Financial Reporting & Analysis: Generate comprehensive financial reports, track key performance indicators (KPIs) for the billing team, and analyze data to improve billing accuracy, payment turnaround, and overall revenue cycle efficiency. Present findings and suggestions to senior leadership.

Training & Development: Provide regular training to staff on payer regulations, coding updates, billing best practices, and compliance requirements. Ensure that all billing personnel are up-to-date on changes in regulations and procedures.

Collaboration with Cross-functional Teams: Work with clinical teams, coding specialists, revenue cycle management, and other departments to ensure seamless coordination across the organization, addressing any issues that may affect the billing cycle and patient financial services.

Skills:

Advanced knowledge of billing and coding, including ICD-10, CPT, and HCPCS codes. Familiarity with HIPAA, CMS guidelines, and payer-specific regulations. Strong understanding of payer requirements, medical policies, and billing guidelines. Ability to interpret complex billing regulations and provide guidance on compliance and best practices. Excellent leadership, organizational, and team management skills. Exceptional communication and negotiation skills when dealing with insurance companies, patients, and internal teams. Analytical skills to interpret billing data and trends, with the ability to implement corrective actions. Proficiency with Epic Electronic Health Record (EHR) system and billing software.