ESSENTIAL SKILLS AND EXPERIENCE:
- Responsible for planning, organizing and managing billing department employees
- Responsible for the recruitment, retention, and development of billing staff
- Oversee billing operations performance in a multi-site environment
- Support systems implementation upgrades and improvements in our billing and financial systems
- Ensure customer needs are identified, monitored, and practices modified to maximize customer satisfaction within established standards
- Motivate, facilitate, mentor and coach subordinates to deliver high quality, cost effective services. Maintain cost to collect ratios
- Ensure development of operating procedures in alignment with quality system
- Bachelor degree or equivalent work experience required
- High school diploma or GED from an accredited institution required
- 7 + years of progressively responsible managerial experience in medical billing
- Excellent written and verbal communication skills
- Working knowledge of Microsoft Office suites, including Excel
- Thorough knowledge of medical terminology, anatomy, physiology and disease process
- Knowledge of medical reimbursement methodologies
NONESSENTIAL SKILLS AND EXPERIENCE:
- Bilingual English and Spanish
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job related selection or promotional criteria.
- Oversees work of non-supervisory employees engaged in reviewing visit coding, posting charges, payments, and adjustments, processing claims, working denials, customer service calls, working collections lists, maintaining related files and logs, and checking patient eligibility
- Proactively identifies problems and assists in solving payment and other business office issues
- Monitors processing of claims for reimbursement and ensures all necessary documentation and attachment are included with claims. Interacts with physicians and administrators to coordinate communication of billable services to patients
- Orients and trains area employees in department policies and procedures and assists staff in carrying out their work by responding to more complex questions and problems
- Assists in the resolution of patient complains and concerns and resolves
- Gathers and exchanges information necessary to ensure timely processing and reimbursement of claims and to promote maximum cash flow and reduce outstanding days in accounts receivable
- Runs regular reporting to monitor and ensure that department and employee goals are being met
- Helps with back-logged department responsibilities
Additional Duties and Responsibilities
- Other duties as requested or assigned.
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must 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.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.