- 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
- 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
- Certification through AAPC or equivalent
- Revenue Cycle Certification
- CPAR
- High School Diploma or equivalent
- Higher education in relevant field
- Valid Driver's License and satisfactory motor vehicle record (MVR).
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Trauma Revenue Billing Support Manager Full Time - Columbus, United States - Hughston Clinic
Description
Position GoalManage all aspects of billing, and assigned staff and Billing Support Services to ensure prompt and accurate payment for claims including patient satisfaction.
Position Responsibilities
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