Job Title:              Billing Manager   

Reports to:           Director of Billing & Collections          

Location:              Irving, TX

FLSA Status:        Exempt

Revision Date:     11/09

ESSENTIAL FUNCTIONS:

Overall Responsibilities   

The Billing Manager position is responsible for all support aspects of the Central Business Office.  This position will oversee account creation, claim submission,  and clerical support for the entire department as well as assist in the DME Coordinator with CPAP/BiPAP and Supplies Billing.  Additionally, this position will submit and follow up on all hospital invoicing, processing refund requests, credit balance management, physician interpretation billing, records archiving, and quality assessment.  Usual management responsibilities of staff include training of all new employees within the billing area.

Direct Responsibilities:

Oversees account creation and claim submission, ensuring that all patient encounters, Physician Interpretation, and Hospital charges are entered into the Billing System; all charges are captured and all claims are billed to the appropriate party in a timely fashion.

·         Oversees the DME Coordinator and assists with CPAP/BiPAP and Supplies Billing

·         Oversees Credit Balance Management ensuring that Payment Posters are identifying all credit balances and resolving appropriately.  Approves all refund and recoupment requests.[collector/payment poster manager function]

·         Reconciles monthly physician interpretation charges and revenue. Prints reports for each physician by location.

·         Reconciles monthly Hospital Claims and submits monthly invoices to the hospitals, follows-up on outstanding invoices and reconciles payments must do the following:

o   Obtain monthly hospital spreadsheets from field offices for billing

o   Price spreadsheets based on contract agreements

o   Generate monthly hospital invoices and send to Clerical Support Clerk to mail

o   Reconcile hospital invoice expenses with check receipts received

o   Resolve payment discrepancies and reconcile balances

o   Maintain collaborative working relationship with hospital contact person(s)
Promptly respond to correspondence received from hospitals

o   Document all collection activity

·         Works with field offices to resolve all missing documentation issues and forwards problematic/unresolved accounts to the Director for referral to a collection agency.

·         Answers escalated patient and payor billing questions as needed to maintain patient and payor satisfaction and quality of care. Also, identifies and assesses areas for improvement and participates in process improvements, as needed

·         Serves as the first point of contact for the staff when billing questions/concerns arise.

·         Develops and maintains relationships with contacts at the Top Payors to assist Collections unit with follow-up and collections. Additionally, maintains all electronic Payor Website Log-Ins and Passwords.

·         Identifies and assesses areas for improvement and participates in process improvements, as needed

·         Serves as the first point of contact for the staff when questions/concerns arise.  Meets daily with the Director to discuss major issues/concerns and responsible for archiving records offsite. 

·         Responsible for Quality Assessment (QA). He/she will perform random audits to ensure the accuracy of account creation, charge capture, payment posting and identification of low allowable appeals. He/she will also review DME coordination, ensuring the accuracy of discount negotiations and attainment of proper compliance documentation.

·         Maintains professional demeanor and communication at all times to include keeping all patient medical information confidential and assists co-workers and staff as needed.

·         Performs other related duties as required or assigned.

Problem Resolution

Responsible for addressing and resolving billing issues with labs and market staff by identifying performance improvement areas and ensuring corrective action is taken.  Participates in design sessions conducted to improve the company’s operational systems and processes.

Company policies, procedures and regulatory compliance

Ensures compliance to company policies, procedures, standardized processes and best practices along with federal, state, local and JCAHO regulations for the region, and resolution of customer complaints. 

Supervision/Staff Development

Supervises the activities of records archiving, and subordinate staff as well as providing direction and guidance on work assignments. Provides timely coaching and feedback to staff and ensures work assignments are completed accurately, efficiently and timely. Ensures individual and team benchmarks are achieved. Responsible for the assisting in hiring, coaching, performance appraisals and discipline of subordinate staff.

Orientation

Ensures the orientation and any certification program is administered in a timely fashion for customer service personnel. Provides feedback and recommendations related to training & development on current and/or future changes to the staff training programs. Ensures all  training is conducted in accordance with federal, state, local, JCAHO, compliance and legal requirements and is completed timely.

ADDITIONAL DUTIES AND RESPONSIBILITIES:

Regular and consistent attendance and punctuality is considered an essential job function of this position as well as performs other related duties as directed by supervisor.

Physical Demands:         

·         Moderate physical effort (lift/carry up to 40 lbs), Prolonged, extensive or considerable sitting/reviewing computer work. 

·         Manual dexterity and mobility, Considerable reaching, stooping, bending, kneeling and crouching, Requires an 11” forward reach plus overhead reaching.

Working Conditions:      Local travel in a office and hospital environment              

QUALIFICATIONS:

Education and/or experience

·         High School Diploma or equivalent experience, preferred.

·         Minimum three years experience in medical billing & collections

Skills    

·         Experience with Centricity or Fastrack is preferred.

·         Extensive knowledge of CPT-4 and ICD-9 coding guidelines, as well as insurance reimbursement guidelines and sleep diagnostic practices

·         Moderate computer skills

·         Managerial skills

·         Customer service skills

·         Interacts with senior management, all office contacts, patients, and others