Position Goal

Manage all aspects of billing, and assigned staff and Billing Support Services to ensure prompt and accurate payment for claims including patient satisfaction. 

Position Responsibilities

• Manages clinic claims for electronic or hard copy mail and forwards to appropriate third party payors.
• Reviews claims to make sure that the payor specific billing requirements are met.
• Follows up on billing to ensure accuracy of the work and look for payer denial trends.
• Determines and applies appropriate adjustments to claims.
• Answers staff questions and updates accounts as necessary.
• Manages assigned Payor hold/Manager hold buckets.
• Manages and educates team to ensure KPI performance is within or greater than expectations.
• Manages and approves payroll activities for assigned staff members.
• Assists patients with questions/payments on their accounts (escalated)
• Assures team members appropriately appeal insurance claims in a timely manner.
• Assures team members research and write up refunds in a timely and compliant manner.
• Establish/maintain relationships with Hughston staff and physicians.
• Responsible for training new hires under the assigned umbrella.
• Works with assigned locations as needed to provide training to ensure team members are following accurate billing practices including travel to remote locations as needed.
• Escalates billing/reimbursement issues to payor account representatives for resolution.
• Responsible for direct communication to providers, executive leadership, management and staff members.
• Maintain portal access for new users as an administrator of payor sites.
• Provide financial reporting to leadership and/or physicians.
• Serve as primary representative for payor forums.
• Direct backup to the CRCO for financial reporting.
• Direct back up to Director of Reimbursement.
• Provide education to CBO staff members on a monthly basis.
• Manages the day-to-day activities of the billing support team and acts as Central Billing office subject matter expert as it relates to self-pay patient activity and batch posting.
• Implementation coordinator/manager of product rollouts directly related to patient account/revenue cycle enhancements.
• Escalation point of contact for patient billing grievances.
• Responsible for ensuring effective communication and education of vendor enhancements across all staffing levels/departments.
• Evaluates staff performance assessments and annual evaluations, implementing action plans as warranted. 
• Plans and directs workload for assigned staff support.
• Assists with quality review and staff education to ensure State, Federal and payor refund requirements, guidelines and regulations are being followed and are compliant.
• Assists in the development of revenue cycle operations policy/procedures.
• Primary representative/ relationship liaison with third party vendors for products directly affecting self-pay or other outsourced accounts receivable.
• Monitors productivity and engages staff to maintain departmental expectations to ensure expected performance goals are met.
• Provides supervision to direct staff, inquiring parties to include training, education, work allocation and problem resolution.
• Primary resolution contact for patient posting or batch discrepancies.
• Oversee reconciliation of USBANK activity to Athena and ensure that Cash reconciliation specialist is working any discrepancies.
• Oversee posting of patient and insurance payments in Athena by Financial Analyst; ensure payments are posted promptly and accurately.
• Oversee management of correspondence dash board and distribution of patient portal communication
• Primary representative for special projects as assigned by Executive Management.
• Manage and oversee accesses to multiple payer websites or TPA sites to obtain EOB’s, claim status for each elective provider group.
• Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for staff when applicable

Experience:

Required:

• Three years of medical billing experience along with one year supervisory experience required. 
• Must have knowledge of CPT and ICD-10-CM and medical terminology.
•  Familiarity of reimbursement methodologies and schemes along with State, Federal and Payer Guidelines.
• Certifications remain active at all times.
• Knowledge of current practice management system functionality.
• Knowledge of State Law Medical Billing Requirements
• Knowledge of Federal, Commercial and Workers Compensation billing requirements

 

Preferred:

• Certification through AAPC or equivalent
• Revenue Cycle Certification

• CPAR

Education:

Required:

• High School Diploma or equivalent

Preferred:

• Higher education in relevant field

Special Qualifications:

Required:

• Valid Driver’s License and satisfactory motor vehicle record (MVR).

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.