Billing Specialist Manager-Full-Time (M-F 8-4:30)-Billing Department

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    *Northern California Medical Associates is an Equal Opportunity Employer

    JOB TITLE: Billing Specialist Manager

    LOCATION: Santa Rosa, CA

    JOB STATUS: Exempt

    GENERAL SUMMARY OF DUTIES: Responsible for managing the accounts receivable for all physicians. Responsible for managing the review and resubmission of claims on all denials from health plans. Recommend changes in policies and procedures as needed. Complete and maintain monthly/quarterly reports to management as needed. Manage a team of Billing Specialists.

    SUPERVISION RECEIVED: Reports to Director of Business Services

    SUPERVISION EXERCISED: Supervision of assigned staff

    TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting, some bending, stretching and occasional lifting of up to 25 pounds. Working in an office environment. Working under stress and use of telephone required. Requires manual dexterity to operate keyboard, calculator, copy machine and other office equipment. Requires eyesight correctable to 20/20 to read numbers, letters and computer monitor. Requires hearing within normal range for telephone use.

    TYPICAL WORKING CONDITIONS: Normal office environment

    EXAMPLES OF DUTIES: (This list may not include all of the duties assigned.)

    1. Manage all aspects of account follow up for all account receivables and physicians.

    2. Manage team of Billing Specialists.

    3. Provide training to Billing Specialists as needed.

    4. Support Billing Specialists with trouble shooting and problem solving techniques.

    5. Monitor accounts receivable and maintain 90 days and over balance at 16% or less.

    6. Monitor daily Denial Report to verify denials are being worked by Billing Specialists in timely manner and are processing denials appropriately.

    7. Identify trends in denial pattern and recommend policy or system changes as needed to reduce denials.

    8. Monitor RCM to ensure denials are being worked by Billing Specialists in a timely manner.

    9. Oversee Unfunded Trauma aging and submit eligible charges to Santa Rosa Memorial Hospital on timely basis.

    10. Monitor payments on Unfunded Trauma charges.

    11. Conduct regular staff meetings with assigned staff.

    12. Recommend and develop policy and procedure changes as needed based on denial and reimbursement patterns.

    13. Develop and maintain reports required by management.

    14. Assist with month end close and prepare/distribute close reports as requested.

    15. Delegate responsibilities of work activities and functions to subordinate staff.

    16. Assist in developing and implementing short-and long-term work plans and objectives.

    17. Understand and implement organizational policies and procedures and make recommendations for policy and procedure changes if needed.

    18. Develop guidelines for prioritizing work activities, evaluating effectiveness and modifying activities as necessary.

    19. Assist staff with establishing deadlines for work assignment and completion. Monitor work status and progress.

    20. Identify problems, evaluate and recommend solutions.

    21. Assist in the recruiting, hiring and development of staff.

    22. Ensure requests for information are handled promptly and effectively.

    23. Participate in professional development activities.

    24. Assist executive staff in implementing and maintaining financial productivity of unit or department.

    25. Maintain comprehensive knowledge and understanding of health care payment systems, including fee schedules, capitated and managed care contracting issues, etc.

    26. Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.

    27. Attend meetings as requested.

    28. Perform related work as required.


    Knowledge, Skills and Abilities:

    Knowledge of organizational policies and procedures including medical office procedures.

    Knowledge of office, fiscal and human resource management, including accounting principles.

    Knowledge of ICD-9, ICD-10, CPT and HCPCS coding; insurance company operating procedures, contracted reimbursement rates and ANSI codes.

    Knowledge of HIPAA guidelines.

    Skill in gathering, analyzing and evaluating data through appropriate reporting mechanisms.

    Extensive skill in database functionality, Microsoft Word and Excel.

    Ability to manage and maintain effective working relationships with assigned staff, other employees, patients, physicians, organizations and the public.

    Ability to exercise initiative, problem solving and decision-making; and communicate clearly both written and verbally.

    Education: High school diploma or GED

    Experience: Minimum five years of billing experience in a health care organization.

    Certificate/License: None



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