Billing Manager Physician Organization

Job Profile Summary

This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Patient Financial Services duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted claims, and performs appeals for non-clinical denials, etc. An organizational related support or service (administrative or clerical) role or a role that focuses on support of daily business activities (e.g., technical, clinical, non-clinical) operating in a "hands on" environment. The majority of time is spent in the delivery of support services or activities, typically under supervision. A senior level role that requires broad knowledge of operational procedures and tools obtained through extensive work experience and may require vocational or technical education. Works under limited supervision for routine situations, provides assistance and training to lower level employees, and problems typically are not routine and require analysis to understand.

Job Overview

Performs a wide variety of billing and administrative services including managing and maintaining the billing databases. Monitors workflow and all billing activities to ensure continuous, efficient and smooth operation of the department. In addition, supports office-related functions such as answering telephones, greeting visitors, and providing general office assistance.

Job Description

Minimum Qualifications:

1. High school diploma or equivalent.

2. Two (2) years of progressively responsible experience in the healthcare environment, with hospital and professional billing background, as well as prior project coordination and administrative support.

Preferred Qualifications:

1. Associate's degree in Business or related field.

2. Four (4) years of progressively responsible experience in the healthcare environment, with hospital and professional billing background, as well as prior project coordination and administrative support.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Works on special projects related to revenue, charge capture, and documentation. This involves knowledge of and expertise in complex surgical services billing requirements.

2. Remains educated on surgical services billing issues, and makes improvements to plan as needed and as billing requirements change. Becomes expert on charge flow and billing requirements.

3. Tracks missing documentation and records; develops systematic methods for maintaining the program with accurate record keeping, as well as develops improvements to current plan.

4. Provides backup to general hospital billing personnel. This duty may include the following: entering billing data into billing systems, ensuring and all charges have been appropriately billed, as well as developing new tracking and audit systems for billable charges.

5. Reports statistics monthly.

6. Provides to other members of the billing team during vacations and time away.

7. May perform diversified administrative duties project work at the request of the Supervisor.

8. Utilizes a variety of software packages and trains and assists staff with questions regarding software use.

9. Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the working group's achievement of goals, and to help foster a positive work environment.

Physical Requirements:

1. Normal office environment.

Skills & Abilities:

1. Knowledge of hospital billing activities.

2. Familiarity with or willingness to learn ESI, SMS, PICIS and NEHCF procedures.

3. Ability to work with great attention to detail, with relatively few errors.

4. Ability to establish priorities, setup appropriate project tracking methods, and use appropriate follow-up skills to see projects to completion.

5. Ability to multi-task and handle a diverse and heavy workload.

6. Ability to function independently and exercise excellent judgement.

7. Knowledge of personal computer systems. Proficient in Microsoft Office products (Word, Excel, Access, Outlook) as well as other software programs.

8. Excellent communication, organizational, and interpersonal skills.

9. Ability to follow departmental policies and procedures.

10. Ability to operate standard office equipment (e.g., personal computer, fax machine, calculator, copy machine, etc.).