Job Details

Job Summary

The Billing Manager, under the supervision of the RCM Manager and the Director of Finance & Billing, will manage all aspects of the Billing Department including billing related tasks, processes, and procedures to ensure smooth financial operations for the billing department. This includes, but is not limited to claims processing, revenue monitoring, and quality improvement initiatives. This role is extremely process oriented, as the Billing Manager will oversee all Billing department processes and ensure each is being performed effectively and efficiently by the team of Billing Specialists. The Billing Manager will have a continuous improvement outlook, able to identify, plan, execute, and review necessary changes in various billing processes or workflows to maximize revenue and positive patient billing outcomes.


Essential Functions (not all inclusive)

• Lead, mentor, and manage a team of Billing Specialists, fostering a culture of accountability and continuous improvement.
• Execute good judgement and decision making while considering cash flow requirements, to ensure cash flow remains consistent and is not disrupted.
• Manage the Billing Department and oversee training, tasks, and overall performance, to ensure accurate and efficient billing processes, therefore maximizing revenue.
• Develop and present continuous improvement opportunities to gain efficiencies, improve quality or revenue cycle outcomes.
• Create, develop, and manage Billing Department training structure and schedule for billing team staff regarding billing, other revenue cycle related tasks, and SOPs.
• Oversee knowledge share material is published and accurate for Billing Team.
• Under the RCM Manager's guidance, track, review, and follow up on team attendance. Initiate concerns and recommend disciplinary actions as needed.
• Assist with candidate recruiting, screenings, and interviews to provide final staffing recommendations to the RCM manager and Director of Finance and Billing
• Organize, develop, implement, and maintain revenue cycle standard operating procedures (SOPs).
• Research and maintain current and new regulatory, compliance, and best practices for all insurance types including Medicare and Medi-cal (Medicaid).
• Identify, research, and resolve system issues through direct contact with payors and software vendors.
• Work closely with the Practice Management and EMR system to identify and resolve systemic issues.
• Manage overall revenue management including satisfying timely filing requirements, clean claims submission, maximizing billing revenue and collections, and resolution of denied/rejected claims.
• Under the direction of the RCM Manager, identify and delegate tasks or special projects as they arise to minimize disruptions in revenue and the overall workings of the Billing Department.
• Monitor A/R aging and payment reports monthly to identify trends and underpayments with various insurances; investigate causes and takes appropriate steps toward prompt resolution using professional judgement to maximize overall collections.
• Under the direction of the RCM Manager follow up on audit findings and implement necessary changes to ensure coding and billing errors are kept to a minimum.
• Generate and analyze weekly reports to track KPIs, metrics, identify trends and support strategic decision making under the direction of the RCM manager and Director of Finance & Billing.
• Work with the billing team to address problems negatively impacting the revenue cycle, KPIs, and metric, under the direction of the RCM Manager and Director of Finance & Billing.
• Provide exceptional customer service skills and positive personality attributes.
• Manage claims review, denial review, and overall A/R analysis to ensure maximum productivity.
• Provide technical expertise to the Billing Team to ensure accurate billing.
• Perform special projects and other duties as requested.
• Comply with departmental policies and procedures.
• Responsible for showing up to work on time and being available to all team members during work hours.
• Work well with all staff members including Management, Administration, Providers, and Front Office team.
• Provide personal commitment and ownership to enhance knowledge, skills, and abilities in healthcare billing and collecting.
• Maintain patient confidentiality and information security, adheres to all HIPAA regulations and requirements.
• Follow and adhere to CDC requirements for healthcare facilities.
• As an exempt employee, you will be required to work as long as it takes to perform your job. You are not eligible for overtime compensation.

A bachelor's degree in healthcare administration or related field such as business, finance, or accounting, with relevant experience demonstrating progressive development of responsibilities: or equivalent, a minimum or ten+ years' experience in direct medical billing (preferably urgent care).

Medical Billing Certificate (preferred).