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* Northern California Medical Associates is an Equal Opportunity Employer
Position title: Director of Business Services
Department: Business Services
Location: Santa Rosa, Calif.
Schedule: Full-time, exempt
Manages and provides oversight of all billing and collection activities in the Business Office including coding, billing, payments, collection, credentialing and malpractie. The Director of Business Services works collaboratively with management team, carriers, clients and other departments to ensure services delivered are aligned with business needs, while planning, organizing, and managing both resources and processes in order to achieve operating efficiency and revenue growth.
Duties and responsibilities (includes, but is not limited to the following):
- Assists CEO, Director of Finance and Director of Regional Operations in maintaining billing and collection targets within industry standards and company objectives.
- Establishes and recommends policies and procedures. Makes recommendations for improvements.
- Develops management and trending reports to show efficacy of billing, coding and collection efforts.
- Coordinates efforts for timely month end billing close.
- Maintains aged accounts (+90-days) at 15% (or lower) of total AR balance.
- Maintains average days in AR at 40.
- Regularly audits documentation and coding to assure compliance with Medicare and industry guidelines/standards.
- Gathers and analyzes information. Develops new procedures to improve quality and quantity of work processed.
- Coordinates publication of training documents.
- Supervises and trains/orients assigned personnel, outside office staff and physicians.
- Evaluates performance and recommends merit increases, promotions, disciplinary action and communications regarding the business office.
- Works with Director of Finance and IT to update and evaluate needs of computer system.
- Conducts and attends physician and employee education meetings and seminars regarding coding, billing, and related matters.
- Ensures compliance with governmental regulations and standards of performance in management of billing staff and billing and collection of medical charges.
- Oversees payer contracting and provider credentialing unit.
- Serves as the company’s Compliance Officer regarding billing compliance and HIPAA.
- Monitors effectiveness of collection efforts and maintains insurance billings are current within the established time frame specified in the department policy.
- Conducts regular and periodic meetings with staff to ensure implementation of procedures/projects.
- Manages licensing compliance requirements and CLIA/State Laboratory Permits.
- Interprets payer contract language, understands contract details and major provisions of agreements as they relate to day to day operations (e.g., timely filing limits, retroactivity, refunds, rate schedules, term notices, credentialing requirements, etc.).
- Assures compliance with regulatory requirements and product requirements in relation to provider contracting functions.
- Implement processes to simplify and improve contract administration.
- Oversees professional credentialing to ensure that employed physicians and mid-levels applications are completed with third-party payers and hospitals.
- Provides oversight of all credentialing and re-credentialing functions adhering to established processes and timeframes.
- Serves as the point of contact for all entities with respect to credentialing.
- Develops a thorough understanding of systems, processes and payer specific reimbursement mechanisms and billing requirements, contributing in the proactive identification of opportunities for revenue cycle improvement and enhancement.
- Manages relationships with various consultants, vendors, and collection agencies that support the collection process.
- Directs and oversees development plan for reimbursement and claims leaders and staff, ensuring that it meets objectives.
- This position oversees Business Office department managers, Contracting and Credentialing department, and payment processors.
Education, licensure and/or certifications
- Bachelor’s degree in health care administration, business or a related field, preferred.
- AAPC or AHIMA certified
- Minimum five years’ experience in progressively responsible management positions in the health care industry.
Knowledge, skills and abilities
- Proficiency in medical billing and accounting.
- Maintains a thorough understanding of health care patient systems, including fee schedules capitated and managed care contracting issues, etc.
- Exceptional organization and communication skills.
- Skill in exercising initiative and judgment in problem solving and decision-making.
- Skill in negotiating and procuring services from outside agencies and vendors and insurance.
- Extensive knowledge of medical office procedures, CPT, ICD-10, HCPCS coding, and insurance company operating procedures.
- Thorough knowledge and understanding of all facets of providing services to Medicare patients.
- Ability to convey health care reimbursement knowledge to staff, patients and physicians.
- Ability to recognize, evaluate, and solve problems and correct errors.
- Ability to maintain effective working relationships with other employees, patients, physicians, organizations and the public.
- Ability to use multiple systems including practice management system, electronic health record (EHR) and Microsoft Office applications.
The physical demands described here are representative of those that may need to be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Requires frequent sitting, standing, bending or stooping for prolonged periods.
- Requires occasional lifting up to 25 pounds.
- Requires manual dexterity to operate keyboard, calculator, photocopy machine and other office equipment.
- Requires eyesight correctable to 20/20 to read numbers, policies and computer screen.
- Requires hearing within normal range for telephone use.
- Occasional high stress work may require dealing with angry or potentially volatile individuals.
The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Work is performed in an office environment and requires both desk and counter work. Frequent contact with employees, physicians, patients, and outside agencies.