POSITION SUMMARY: Under the direct supervision of the Finance Director, the Billing Manager will promote the financial viability of Charles Drew Health Center by effectively planning and administering the activities and policies for all patient accounting and related functions, including accounts receivables, billing, credit and collections. The Billing Manager will be the subject matter expert of CMS, Medicare, Medicaid and other primary Third-Party Payor rules and requirements. The Billing Manager will further uphold the integrity of patient care and the patient experience through customer service best practices and all patient accounting and related functions.
POSITION COMPETENCIES/ESSENTIAL FUNCTIONS/DUTIES & RESPONSIBILITIES
- Responsible for Billing staff life cycle to include hiring, onboarding, professional development, and disciplinary action.
- Provide leadership, teambuilding, and supervision when necessary.
- Monitor and maintain procedures for efficient and accurate processing of encounters.
- Monitor and maintain patient billing procedures.
- Ensure compliance with state and federal statutory requirements including the Centers for Medicare and Medicaid Services (CMS), Nebraska Medicaid Program and Nebraska Department of Health and Human Services (DHHS).
- Work collaboratively with the Finance Director to ensure approved fee schedules, sliding fee discount schedules, funding options and third party contracts are properly set up in the electronic Practice Management database.
- Ensure that all encounters and pertinent information to be sent to the billing agent on an at least weekly basis.
- Identify and establish relationships with third party insurers to improve patient revenue.
- Function as the primary staff liaison with outsourced billing, credentialing and collection firms as applicable to ensure adherence to CDHC policies, procedures and goals.
- Manage and monitor the process for ensuring credentialing and enrollment of CDHC locations and providers to maximize third party insurer patient revenues, including Medicare, Medicaid and primary commercial plans.
- Supervise and monitor the reconciliation of third party insurance remittances and cash collections.
- Manage policies and procedures that will address all patient problems with the Billing process and support developing payment plans with patients where required, such as:
- Problems paying assigned fee
- Delinquent accounts
- Third Party insurance coverage not covered at the CDHC
- Create and monitor reporting to identify revenue gaps and areas of opportunities for maximizing revenue. Identify and implement plans to close gaps and maximize revenue.
- Establish and maintain a patient friendly environment where consumers (patients and community members) are educated on options available to them based on their eligibility for insurance and/or related third party coverage, the CDHC Sliding Fee Discount Program, government and public financial resources, community financial and supportive resources, including CDHC grant and/or partner agencies.
- Coordinate and collaborate with Registration and Intake to ensure that all pertinent patient information is captured at registration.
- Coordinate and collaborate with Patient Financial Services (aka Eligibility and Enrollment) to ensure that patients are advised of insurance and financial assistance programs available in Nebraska and active CDHC funding and partnership arrangements.
- Coordinate and collaborate with other patient support services, such as registration, reception/phones staff and provide backup staffing as needed.
- Lead continuous performance improvement efforts and continually seek mechanisms to streamline and automate processes within department.
- Develop procedures to monitor and review compliance with processes and procedures related to registration, sliding fee program eligibility, and other areas of internal controls. Collaborate with auditors (internal and external) during review and identify additional CDHC staff for assistance when needed.
- Participate in professional development activities, including keeping current with trends and best practices in health center operations, and personal leadership and management development.
- Provide leadership and management of special projects, as assigned.
- Other duties, as assigned.
POSITION REQUIREMENTS
- Bachelors degree in Business Administration, Public Health, or Public Administration required.
- At least 5+ years of experience working with Medicaid, Medicare and third-party reimbursement.
- Expertise of community based primary care models, more specifically Federally Qualified Health Centers.
- Excellent track record of superior customer service.
- Clerical accuracy within electronic systems, such as Practice Management software.
- Established supervisory skills, professionalism, integrity, responsibility, and dependability.
- Demonstrated mastery of critical thinking, analytics, problem solving and sound decision making skills required. Demonstrated ability to interact and communicate effectively with individuals at various levels both inside and outside of the organization, often in sensitive situations.
- Proficiency with Microsoft Office particularly Excel and PowerPoint.
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