Medical Billing Manager

Job Details

LAS VEGAS, NV

Full Time

Management

Description

JOB DESCRIPTION AND PERFORMANCE STANDARDS

Job Title: Medical Billing Manager

Direct Report: Chief Executive Officer

FLSA Status: Exempt

Hours Worked: 40+/week

BASIC PURPOSE OF THE JOB

Provide leadership and supervision to the Medical Billing and Authorization Departments. Develop, implement, and oversee policies and procedures to ensure efficiency and accuracy.

ESSENTIAL FUNCTIONS

Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. The following are the essential functions of the job.

Duties:

Responsible for the overall direction of the billing and prior authorization departments.

Maintain training manual and train staff members on all aspects of their position.

Stay abreast of insurance rules pertaining to billing and prior authorizations, as well as ensuring the staff is aware and trained.

Balance department monthly and work with the Controller to resolve any discrepancies.

Review the entire billing and authorization processes, the effectiveness of the protocols, and assess staff roles to improve the overall productivity of both departments.

Work with insurance companies and adjusters to resolve problem accounts, re-file and reopen claims, and file appeals.

Work with staff to handle questions and issues regarding charges, payments, and denials, and follow up to ensure they get resolved.

Complete monthly productivity reports to ensure departments are meeting company standards.

Evaluate insurance contracts and update fee schedules accordingly.

Conduct audits on encounters, coding, and payments for accuracy.

Analyze reimbursement procedures and accounts to obtain maximum reimbursement.

Produce monthly reports for various accounts and turn into the Controller/CEO.

Perform other duties and special projects as assigned.

Qualifications

MINIMUM REQUIREMENTS

Medical billing and coding certification is required, CPC or RCC or it must be obtained within 6 months of hire.

Three years previous experience as a Billing Manager in a healthcare setting.

Two years previous experience researching unpaid and denied insurance claims.

Familiarity with Medinformatix EHR software a plus.

Knowledge of reimbursement and billing to include CPT, ICD10, insurance verification, and obtaining prior authorizations.

Must be able to run financial reports and ensure monthly balancing.

Possess the ability to approach situations with an innovative mindset and think outside of the box.

Must have familiarity with secondary billing, appeals and contractual adjustments.

Ability to understand, write, speak and follow English instructions. Bilingual abilities preferred.

MENTAL AND EMOTIONAL REQUIREMENTS

Must be able to exercise judgment and make decisions independently.

Ability to use excellent communications skills.

Ability to use problem solving skills effectively.

Ability to manage stress appropriately.

Ability to manage time efficiently.

Ability to handle multiple projects and prioritizes effectively.

Possesses common sense understanding to carry out instructions/guidelines furnished in oral and written form.

ANALYSIS OF PHYSICAL DEMANDS

Physical Demands Description

Standing - This position occasionally requires standing to scan, fax and copy job related documents to carry out job duties.

Walking - This position frequently requires walking short distances of up to 20 yards to communicate with staff and direct report.

Sitting - This position consistently requires sitting for a majority of the day to complete essential job duties on the computer.

Lifting - This position occasionally requires lifting objects such as office supplies weighing up to 15 lbs.

Carrying - This position occasionally requires carrying objects weighing up to 15 lbs. for short distances to carry out essential job related duties.

Pushing

Pulling

Reaching - This position consistently requires reaching with hands and arms less than 2 feet in all directions for items necessary to complete job duties (i.e. stapler, paper clips, phone, keyboard, calculator, etc.)

Handing - This position frequently requires handing paper or objects to staff or direct report.

Climbing

Balancing

Bending - This position frequently requires bending/leaning from the waist in all directions to carry out essential job duties.

Stooping

Kneeling - This position rarely requires kneeling to file or assist with possible computer issues.

Crouching

Crawling

Speaking - This position consistently requires verbal abilities to effectively communicate with patients, staff, insurance carriers, and direct report on a daily basis to reach optimal work outcomes of the position.

Hearing - This position consistently requires auditory abilities to efficiently listen and effectively communicate with all affiliated personnel to carry out essential job duties.

Seeing - This position consistently requires acute visual abilities to carry out essential job duties.

Depth Perception

Color Vision

Is this position closely, moderately or minimally supervised? Moderately

Explanation: This position is moderately monitored by the Practice Administrator.

Does this position have supervisory responsibility (i.e. responsible for hiring, firing, performance appraisals, etc.)? Yes

Does this position have access to confidential information? Yes

Explanation: This position has access to confidential information such as social security numbers, dates of birth, credit card numbers, bank account information and HIPAA information for patients scheduled through our RIS system.

Does this position have access to or handle company funds? Yes

Explanation: This position has limited access to company credit cards, company bank account information, and is listed as an authorized signer for document changes.

Is it important to this position the incumbent be able to read, write and communicate fluently in English? Yes

Explanation: Most affiliated personnel (i.e. staff, doctors, vendors, and affiliated hospitals/locations) and a majority of our staff communicate with our company and facilities in English. Bilingual abilities are preferred.

What kind of work experience (including length of time), training, and/or level of education is necessary for this position? Two to three years previous billing experience in the healthcare industry. The candidate must be able to read, write, speak, and interpret reports and correspondence. The individual must have excellent oral and written communication skills needed for daily communication with vendors, staff, doctors, direct report, billing company and medical carriers. Effective and efficient interpersonal skills are required for a successful work environment.

List any technical skills (typing, computer skills, etc.): The skills required by this position include, but are not limited to, typing, faxing, scanning, copying, and computer literacy in Word, Excel, Outlook, and Billing software.

Working Conditions

Are there particular working conditions associated with this position that should be noted (i.e., working environment, hours of work, travel, work space, etc.)? Yes

Explanation: This position will carry out his/her duties in an average size office space that is generally very quiet. The hours are approximately 8:00 a.m. to 5:00 p.m. Some overtime may be required.