Title: Billing Manager

Billing Manager Role Summary

Department: Finance

Status: Salary

Position Purpose: Mange patient billing and collections ensuring maximization of all revenues for patient services. Plan and supervise daily billing operation and maintenance of Accounts Receivable and assist Finance Director in developing, implementing, and revising departmental policies and procedures. Oversee implementation of training programs and performance improvement to ensure maximum efficiency at all levels of the revenue cycle. Interact with other department supervisors to identify and correct problems regarding billing issues. Recommend or make decisions regarding hiring and staffing and responsible for evaluating staff performance. Performs analytical functions of overall billing data as called for from management, attends monthly meetings, works with Finance Director and auditors, and ensures all billing records are kept in an organized manner. Assist Finance Director in managing any outside third party organizations utilized to assist with billing and collections. Work with practice management system and other software vendors to manage installation, implementation and appropriate ongoing issue resolution.

Required Experience: Practical knowledge of entitlement programs Medicaid, and Medicare and third party billing. Expertise with ICD-9 and CPT coding. Previous experience in use of electronic practice management system(s) including practice management system set-up and reporting. Microsoft office proficiency (Word, Outlook and Excel) Five years’ previous health care billing/revenue cycle operations experience including knowledge of denials management, eligibility processing and electronic payment posting. Experience with 1500 and UB claims processing, knowledge of Part A, Part B and Indiana Medicaid. FQHC experience preferred but not required.

Required Education: Prefered Bachelor’s degree in Business Administration, Finance, Accounting, Healthcare Administration or IT. Expereince may be considered in lieu of Degree and or other Degree could be considered.

Required License: None

PREREQUISITE SKILLS:

 Demonstrated writing skills to effectively communicate with patients and insurance companies and document in patient charts.  Demonstrated reading skills to interpret instructions, manuals, insurance forms, and patient correspondence.  Demonstrated math skills to calculate patient bills and patient refunds.  Demonstrated knowledge of medical terminology.  Demonstrated knowledge of billing requirements, rules, and regulations.  Demonstrated knowledge of claim processing time limitations.  Demonstrated knowledge of insurance company policies and procedures.  Operational knowledge of telephones, fax machines, postage machines, and other office equipment.

 Demonstrated oral communication skills needed to develop patient rapport and ability to discuss patient billing questions.  Demonstrated ability in handling patient confidentiality.  Ability to work with peers in a team situation, supervise and create a positive work environment for team members.  Demonstrated knowledge and skills necessary to provide care appropriate to the age of the patients served.  Demonstrate a functional and technical understanding of applicable scheduling and billing software, Intranet and Internet usage, Excel/Word software, E-mail Usage and Web-based applications. Required to check e-mail daily and use as a source of internal and external communication. Required to understand and utilize electronic medical record technology.

Reports to: Finance Director

Supervise: May directly supervise one or more team members and coordinate billing functions of the Front Office Staff.

Essential Functions:

The following list describes the essential duties of this role. Individuals in this role may not perform all of these duties, or may perform additional, related duties not listed here.  Monitor all patient accounts.  Have or develop a clear and concise understanding of the unique requirements of FQHC billing and claims processing in order to ensure that FQHC Medicaid and Medicare services are reimbursed at the maximum allowed amounts  Assist in developing and maintaining procedures for efficient and accurate processing of encounters during registration  Oversee the monitoring and reconciliation of third party insurance remittances and cash collections  Assist in developing financial counseling processes  Develop and manage patient payment plans as designated by the organizations policies and procedures  Assist in provider credentialing with payers  Participate in trainings relative to FQHC billing to ensure that JPCHC maximizes all revenue sources  Perform on-line maintenance, follow-up, and corrections for all payers available on-line.  Ensure all payments, adjustments and write offs are appropriately applied to patient accounts  Manage credit balances and refunds including providing reports for preparation of Medicare credit balance report  Oversee daily close and balancing process to ensure posting of all charges and appropriate cash balancing procedures  Manage daily claims processing to ensure compliance with organization goals and objectives  Ensure compliance with FQHC program expectations related to billing and collection operations  Oversee and manage billing and collections for patient accounts in accordance with organization policies and procedures

 Assist patients and staff with billing questions  Identify and establish relationships with third party insurers to improve patient revenue including maintaining relationships with managed care organizations  Document conversations with patients in the medical record utilizing appropriate software or guidelines established by the practice.  Be an active and integral participant in the transition to ICD – 10  Actively participate and assist in practice management system maintenance and set up as it relates to patient registration, claims processing, payment posting, eligibility, and reporting  Participate in the maintenance of software upgrades and standardization of office software.  Performs all duties respectful of confidentiality and safety of all patients, and employees.  Adheres to established quality principles and standards established by the JPCHC..

Secondary Functions: Supports the Patient Account Representative, Front and Back Office staff as needed according to skills and abilities.

Competencies: Demonstrates the following competencies:

Attitude/Customer Competencies  Caring, compassionate, and approachable in all customer contacts  Privacy – respects customers’ right to privacy and modesty  Confidentiality – maintains customers’ confidentiality  Telephone etiquette – speaks so that customers hear a smile  Appearance – takes personal ownership in appearance and that of work environment  Initiative – takes necessary steps to fix problems immediately  Providing Direction and Customer Acknowledgment – provides personalized attention by being courteous, friendly, and helpful when responding to customers’ needs  Timely service – recognizes that customers’ time is very valuable; provides them with prompt service  Customer information/education – provides customers with the best information needed to make informed choices

Relationship Competencies/Work Group Competencies  Demonstrates advocacy, respect and truth telling  Demonstrates accountability for own actions  Demonstrates ability to respectfully address interpersonal conflicts  Takes initiative to help others  Demonstrates a learning attitude toward solving problems  Demonstrates openness to change and new learning  Reports to work on time and has regular attendance  Adheres to practice defined dress code  Attends Staff meetings

Ethical Decision-Making

 Respects the needs, expectations and rights of all individuals  Advocates the rights of all to a safe environment  Uses sensitivity to cultural diversity to guide decision-making

Performance Improvement  Identifies work processes and strives to reduce cost and increase satisfaction  Identifies customers and demonstrates understanding of customers’ expectations  Actively works to increase satisfaction of all  Monitors customers’ satisfaction  Takes active role in department process improvement efforts; demonstrates understanding of outcomes  Demonstrates an understanding of responsibilities  Demonstrates diagnostic thinking/reasoning  Utilizes feedback from peers, supervisor, customers to drive performance and behaviors  Prioritizes workplace safety

Community Excellence  Strives for excellence in customer service, patient focused care, and mastery of skills

Reports to: Finance Director Classification: Salary

I have read and understand my Role Summary and agree to fulfill these and other duties as assigned and within my qualifications. I understand that this same Role Summary will be used in evaluating my performance. Regardless of my specifically assigned duties, I realize that it is my responsibility as an employee of JPCHC to do everything in my power to meet the needs of our patients, their families, visitors, and our physicians. Also, I acknowledge a responsibility to actively participate in continuing education for myself and educating and orienting new employees.

______Employee Signature Date

______Supervisor Signature Date