Job description

Billing Manager

Position Summary:
The Billing & Reimbursement Manager is responsible for the oversight of charge entry, benefit verification and billing and collection processes, and ensure timely cash collections.

Key Responsibilities:

• Implement and manage day-to-day billing operations. Responsible for supervision of billing and reimbursement department for multi-million dollar centralized operations in Pain Management, Workplace and Rehabilitation of Toxicology Holdings (?Drugscan?). Functional areas of responsibility include insurance verification, authorizations (if applicable) and other documentation to support initial and subsequent billing, collections, AR, and patient files.
• Leads team to determine all applicable and critical payor requirements. Ensures that system functionality is then established to enforce all of these requirements. Examples of these requirements include the following:
• Coverage levels for all applicable CPT codes
• Member ID guidelines at the plan level of each payor
• Definition of appropriate collection efforts based upon denial, no reply and payment scenarios
• Dx requirement and coverage
• Unusual filing or HCFA requirements by payor
• Other information to enable or ensure payment or effective collection efforts.
• Translate developed business rules to a combination of staff instructions or system programming

• Establish and monitor performance metrics for coding, charge entry, payments and collections.
• Identification and resolution of payment issues with specific payors, including preparation and leadership of all payor projects.
• Supervisory responsibility for following staff members:
• Data Entry Specialists ? responsible for entering initial patient and insurance data into system. This group will also perform insurance verification to the extent required
• Reimbursement Specialists responsible for billing and collecting

• Responsibility for ensuring efficient and effective work process flows exist in all parts of the process to maintain accurate claims submission and maximize cash collections in order to achieve established payment, bad debt and contractual objectives.
• Effectively analyze activity to identify obstacles to achieving established goals.

• Communication of billing, cash collection, unbilled and other goals to team and external constituents
• Provides extensive training to new staff in areas of the system, policies and payor requirements.
• Develops policies and procedures in conjunction with the Director that enhance both the overall effectiveness and adherence to corporate compliance program
• Evaluates and provides recommendations regarding site staffing and future plans

• Actively partner with the following departments to ensure efficient and effective processes are developed and adhered to: Payor Relations, Customer Service, Sales Team, Client Clinics and/or on-site Collectors
• Perform all other duties as assigned by leadership

Minimum Qualifications:

• Bachelor?s Degree in Accounting or related field preferred
• 5-7 years of healthcare billing and/or reimbursement experience required, preferably in a laboratory setting
• At least 3 years? experience leading a team required

Required Licensure/ Certification Skills:

• None

Job Type: Full-time

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