Position Summary

Responsible for supervising, planning, organizing and coordinating the daily activities of the claims processing and accounts receivables for the ambulatory claims under the direction of the Director of the SBO. .Maintains an efficient billing process for all practices. Maintains best practices with registration, charge entry, payment posting and collection follow up processes using MGMA data. Interface with and direct front end of the  with physician offices to promote optimum patient point of service collections including confirming patient’s insurance at time of service and collecting all co-payments including from self-pay patients.  Ensure strong protocols and oversight is in place for the timely submission of chart documentation by providers such that a timely bill can be dropped for the insurer and patient (if any additional out of pocket payments are required).  Ensure that any required edits on the billing side are done timely so that there is little to no delay between a bill being dropped by the office and the bill being issued.  Oversees; the quality of registrations and the completion of charge entry and payment posting. Ensures adequate staffing for the department; evaluates quality of performance against MGMA benchmarks and defined KPIs.  Manage staff to meet or exceed the establlished KPI’s by role and responsibility.

Primary Position Responsibilities

In conjunction with the Admin Director, implements, oversees and maintains an efficient billing and collection process. Establishes workflows including detailed development of tasks within NextGen and any other supplemental systems to manage and continuously improve the quality and productivity of ambulatory billing. Oversees the oversight of the quality of registrations, charge entry, payment posting and follow up for all staff involved in the processes (including monitoring the productivity and quality of PSRs in the practices).  Responsible to evaluate each staff member for quality of performance and adherence to KPI standards. Ensures all personnel involved in billing and collection activities are trained to perform their assigned tasks. Works with Office Coordinators and Practice Managers to assure all billing policies are followed in the ambulatory offices. Works with Office Coordinators, Practice Managers, Regional Managers and Operations Specialist to ensure that all front desk personnel are trained to collect appropriate insurance information and copays; reviews training materials for PSR's periodically and provides necessary updates to the Operations Specialist.  Participates, as required, in PSR training or retraining. Oversees physician Ingenious Med Billing: a) assures that the business office obtains charge sheets from rounding/on call providers. , Communicates missing information in a timely manner to the Practice Manager; c) Trains  Account Reps to assist with Patient charge entry; d) Reviews diagnosis and CPT coding with coder and interfaces with Charge Master (CDM) specialist to ensure that all required CPT codes are accounted for within the master charge master file. Tracks AR days, denials, appeals denials, and recommends policy and procedure changes to reduce and prevent denials and reduce accounts receivable. Member of the Revenue Cycle Steering committee and subcommittees as appropriate. Seeks to improve customer focused professional and patient satisfaction based on patient satisfaction surveys, complaints and other feedback. Shares ideas, information and knowledge with others through mentoring and coaching of staff and colleagues, proactively seeks opportunities to give directions, answer a question, or provide information or reassurance to customers; Acts as a liaison between all key stakeholders in the billing process including the practices, regional managers, and the business office. Conducts monthly staff meeting in conjunction with staff to review performance, billing issues and updates, and anything else related to the improvement of the billing cycle processes. 

Work Contact Group (Internal/External)

All Revenue Generating Departments Revenue Cycle Departments-HIM/Business Office/Patient Access Finance

Reporting Relationships

Reports to (position): Admin Director Supervises (position(s): Ambulatory Billers , Account representatives, customer service and clerical staff

Qualifications

Minimum Education: Required: High School Diploma or Equivalent Certificate and/or Advanced Specialized or Technical Training Preferred: Bachelors Degree in business, operations, or healthcare preferred
Minimum Years of Experience (Amount, Type and Variation): Required: Minimum 7 years  medical billing experience Chargemaster experience required Experience working with Medicare, Medicaid, and private insurance contracts – understanding and interpreting for ambulatory billing practices Preferred:  Experience with hospital and ambulatory billing systems such as Affinity, NextGen, Ingenious Med (Imed), and third party claims clearinghouse vendors
License, Registry or Certification: Required: None Preferred: Billing Compliance, CCAM preferred
Knowledge, Skills and/or Abilities: Required: Demonstrates strong analytical skills. Demonstrates strong written and verbal communication skills (Word/Excel) Demonstrates ability to interact successfully with persons at all levels of the organization. Demonstrates ability to work independently in a productive, goal-oriented manner Preferred: Knowledge of NextGen software’s billing module