Islands Community Medical Services

POSITION SUMMARY:

The position is responsible for leading and planning the day to day operations of the billing department. The individual is responsible for designing, implementing, and enforcing policies and procedures, as well as streamlining effective billing processes. This individual is responsible for effectively communicating with all levels of management and working with staff to assure an overall efficient and effective revenue process. This position is highly visible and requires a strong collaborator with excellent financial acumen.

 

ESSENTIAL DUTIES/RESPONSIBILITIES:

  1. Oversee and streamline billing and collections processes
  2. Supervises direct reports. Supports billing staff to help maximize revenue, while promoting and maintaining a quick accouns receivable cycle.
  3. Oversees Audit
  4. Month-end closing of the billing software information.
  5. Special program/billing planning and implementation.
  6. Establishing and monitoring coding staff schedules and providing necessary training and counseling.
  7. Acting as liaison to Patient Accounts, as well as between coding and clinical staff.
  8. Acting on issues related to failed billing and/or claims.

 

 

SPECIFIC DUTIES/RESPONSIBILITIES:

  1. Respond to e-mail and telephone requests daily.
  2. Works with accounting to provide information necessary to generate financial statements and to accomplish fiscal audits and reimbursement studies.
  3. Manual Payment Posting: Input data from insurance remittance advices and patient payment batches into practice management system.
  4. Electronic Payment Posting: Review and post batches from Electronic Remittance Advices (ERA).
  5. Claims Submission: Processes electronic claims (and paper claims when applicable) to third party payers as necessary to perform job well.
  6. Claims Correction: Review and correct all claims that have been denied or rejected on a weekly basis.
  7. Audits medical records to make sure billing is correct and documented.
  8. Reports quality review reports to management.
  9. Provides documentation training to staff and physicians.
  10. Research problem areas related to coding and payer requirements. Review EOBs with random audits.
  11. Conducts training and education and attends updated training programs on coding, reimbursement, and practice management software.
  12. Conducts internal audits of patient charges and corresponding documentation.
  13. Assists other members of the organization as required or assigned.
  14. Performs other necessary duties as required by the health center to meet the goal of providing primary health care services.
  15. Assists in development and implementation of policies and procedures to maintain optimum reimbursement.
  16. Demonstrate awareness of age specific, cultural and spiritual practices of patients, staff and visitors.
  17. Understands the functional status and physical needs of patients, staff and visitors.
  18. Complies with all OSHA and HIPAA rules and regulations.

 

 

EDUCATION/EXPERIENCE:

  1. Associate’s degree in Business or five (5) years of related medical billing management experience.
  2. Familiarity with Federally Qualified Health Center billing preferred.
  3. Working knowledge of EHR and PM systems (NextGen) preferred.
  4. Strong analytical, oral, written communication skills.
  5. Familiarity with health insurance and other third party billing practices and guidelines.
  6. Proficient in Microsoft Word, Excel, Access, Outlook, and the like.

 

Language/Communication/Organizational Skills:  Must demonstrate knowledge of skills necessary for communicating with all ages and diverse cultures.   Must be able to assess situations, identify issues/problems and prioritize duties.

 

Mathematical Skills:  Principles of Accounting

 

Reasoning Ability:  Uses personal experience, knowledge and other outside resources to make logical decisions to solve problems.

 

 

WORKING ENVIRONMENT/PHYSICAL DEMANDS:

 

Physical Demands:         

The physical demands described here are representative of those that must be met as an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.  While performing the duties of this job, the employee is regularly required to sit, walk, stand; to use hand to finger, handle, or feel objects, equipment, or controls, talk and hear.  The employee frequently is required to reach with hands and arms, stop, kneel, and bend.  Ability to lift, twist, bend, push, pull; lift 10 pounds frequently; 25 pounds occasionally, and up to 75 pounds with assistance rarely. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perceptions, and ability to adjust focus. 

 

 

Work Environment:        

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.  While performing the duties of this job, the employee is occasionally exposed to risk of electrical shock and radiation.  The employee occasionally works near moving mechanical parts and is occasionally exposed to fumes, airborne particles, toxic or causative chemicals.  The noise level in the work environment is usually moderate.

 

THE ABOVE STATEMENTS ARE INTENDED TO DESCRIBE THE GENERAL NATURE AND LEVEL OF WORK BEING PERFORMED BY PEOPLE ASSIGNED TO THIS JOB.  THEY ARE NOT INTENDED TO BE AN EXHAUSTIVE LIST OF ALL RESPONSIBILITIES AND DUTIES.

 

JOB LOCATION:                             Work is performed in an office setting

 

LEGAL COMPLIANCE:

The employee understands and agrees to abide by the policies of Islands Community Medical Services, Inc.

 

DISCLAIMER:

This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.

 

AMERICANS WITH DISABILITIES ACT STATEMENT:

 

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job specific responsibility) either unaided with the assistance of a reasonable accommodation to be determined by the organization on a case-by-case basis.