Please send in all resumes to Christine at Human.Resources@illinoisback.com
Position Title: Medical Billing Manager
Date: May 20, 2013
Reports To: Director of Clinics
SOC Code: 11-9111.00
Position: Exempt ______________________________________________________________________________
Medical billing managers are responsible for making sure that medical data is secure, accessible and accurate for billing purposes. They supervise teams of medical coders and billers who compile patients’ medical records and assign codes for procedures and diagnoses to generate bills for reimbursement to the health care provider. Other duties of medical billing managers include determining budgets for the billing department, overseeing collections processing, providing patient financial counseling, going over insurance pre-authorization and verifications and tracking payments and payment plans.
Duties and Responsibilities:
- Assures that the appropriate codes are used to generate proper billing.
- Has experience and knowledge of ICD codes and CPT codes.
- Responsible for managing the overall billing of electronic and hard copy billing activities, government payer, compliance and follow up.
- Responsible for implementing and maintaining related policies, procedures related to billing and compliance.
- Managers the processing of MCR , MCD and insurance billings.
- Assures that all denials and requests for additional information responses are prompt and within company guidelines.
- Works closely with the finance department to ensure that the organization’s accounting records accurately reflect billing activities and processes and practices are HIPPA compliant.
- Responsible for providing end of month, end of year reports for management.
- Monitors staff performance through monthly audits to ensure work meets department standards and provides regular feedback to staff.
- Improves process flows related to revenue management.
- Process credentialing for all insurance companies for all licensed providers and companies
- Maintain the CAQH database for all licensed providers
- Must train all staff in up to date HIPPA and compliance regulations
- Keeps current and abreast with any insurance changes and regulations
- Provides weekly and monthly reports and meets weekly quotas
- Review and process all insurance appeals
- Process medical record requests for insurance companies, subpoenas, medical provider requests
- Process all audit requests
- Help decipher any insurance verification issues for all clinics
- Answer all billing/coding questions for insurance claims regarding patient claims for all clinics
- Resolve patient billing disputes
- Process insurance requests for claim processing (anything requiring additional information to process the claim)
- Go through all EOBs for non-payment and address the issue accordingly.
- Resolve the EOBs that can be resolved in house or send for payment
- Handle contracting for clinics with insurance companies
- Handle documentation corrections on the EMR software syste
- Monitor license expiration dates and update credentialing database accordingly
- Assist with proper CPT usage for IBI Therapy Protocol
- Assist with revising and supporting documentation
- Serves as primary contact for Medicare credentialing, inquiries and processes
- Handles troubleshooting for clinics regarding patient care once clinic staffs exhausted all other options
- Provides input in development of remedy system specific to IBI needs (coding, medical records)
- Advise other staff regarding issues with medical records and how to correct errors/inaccuracies
- Resolves clinical staff issues when patient presents billing problems in the clinic (dispute/insurance issues)
- Assist with maintaining storage and archiving of records
- Creates and implements new procedures for streamlining new forms utilized within the clinics
- Outline regulations for CMS guidelines and updates, communicate any changes to clinic/corporate staff
- And various tasks and assignments as needed per management.
Skills and Specifications:
- Ability to communicate effectively; must present in a professional, courteous, and tactful manner.
- Knowledge of laws, legal codes, court procedures, government regulations, agency rules and the democratic political process.
- Knowledge of principles, methods and procedures for diagnosis, treatment, and rehabilitation or physical and mental dysfunctions and for career counseling and guidance.
- Brings others together and tries to reconcile differences.
- Determines the kinds of tools necessary to get the job done.
- Experience with ICD-9 and CPT coding a plus.
- Proficient with MS Office, Microsoft Excel, problem management, problem solving and troubleshooting skills.
- Capable of determining the cause of operating errors and decides how to correct these errors.
Education and Qualifications
- Bachelor’s Degree in business, administration or related field
- Three to five years managing successful medical insurance billing operations.
- Minimum of five years of actual work experience
- Experience with Remedy a plus.
Achievement/Effort: This job requires establishing and maintain personally challenging achievement goals.
Initiative: This job requires a willingness to take on responsibilities and challenges.
Near Vision: The ability to see details at close range (within a few feet of the observer).
Oral Communication: The ability to communicate in English information and ideas in speaking to others.
Information Ordering: The ability to arrange things or actions in a certain order or pattern according to a specific rule or set rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
Flexibility of Closure: The ability to identify or detect a known pattern (a figure, object word or sound) that is hidden in other distracting material.
Deductive Reasoning: The ability to make precisely coordinate movements of the fingers of one or both hands to grasp, manipulate or assemble very small objects.