MEDICAL BILLING SUPERVISOR

PURPOSE OF POSITION:  to manage and supervise billing and collection activities to include AHCCCS, Medicare, Commercial Insurance (i.e.: Blue Cross-Blue Shield, CIGNA, Humana, United Health Care, HealthNet, AETNA, etc.) and Private-Pay accounts. The incumbent participates in billing systems design to insure maximum collection of revenue; establishes policies and procedures required for effective billing and collection processes; and responds to issues and concerns of Partners and Administration.  

ESSENTIAL FUNCTIONS (other duties as assigned):

• Coordinates and manages the work of the physician billing, coding, and collection staff;
• Performs technical analysis of payor activity;
• Advises Administration regarding physician billing, coding, and collection issues;
• Evaluates and resolves physician billing-related Electronic Medical Record (EMR) system problems;
• Reviews, coordinates, and updates all compliance issues regarding Federal and State rules and regulations;
• Reviews, coordinates, and updates all billing/payment options and methodologies to insure accurate and timely collection of revenue;
• Reviews, coordinates, and implements all changes to payor claim submission processes;
• Prepares and presents formal and informal instruction to billing, coding, collections, and other assigned personnel;
• Conducts program presentations before senior staff members, Partners, and/or other officials;
• Prepares and administers the annual billing budget;
• Maintains regular and reliable attendance;
• Demonstrates superior seamless customer service, integrity, and commitment to innovation, efficiency, and fiscally responsible activity;
• Works more than forty hours in a workweek without additional compensation to perform assigned job duties, including weekends, evenings, early morning hours, and holidays as required.

Required Knowledge, Skills and Abilities:

Knowledge of:

• plan rules, regulations, and detailed provisions of claim submission requirements;
• Medicare rules and regulations;
• Various EMR systems
• Health Insurance Claim Form (HCFA-1500) requirements for medical billing purposes;
• Accounting principles and practices;
• Commercial insurance claim requirements;
• Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance;
• Electronic claim submissions and remittance procedures;
• Principles and practices of supervision and personnel management.
• ICD-9 and ICD-10 rules and regulations; implementation strategies, etc.

Ability to:

• Perform a broad range of supervisory responsibilities over others;
• Develop and implement plans, policies and procedures for physician billing, coding, and collection operations;
• Read and interpret financial statements;
• Communicate orally with customers, co-workers, and vendors in face-to-face, one-on-one settings, in group settings, or using a telephone;
• Comprehend and make inferences from written material in the English language;
• Enter data or information into a terminal, PC, or other keyboard device;
• Work safely without presenting a direct threat to self or others;
• Produce written documents with clearly organized thought, using proper English sentence construction, punctuation, and grammar;
• Work cooperatively with other employees;
• Monitor or observe data to determine program problems;
• Remain sitting for long periods of time while working at a computer.

ACCEPTABLE EXPERIENCE AND TRAINING:

Five years of experience developing, evaluating, using, and maintaining an EMR and physician billing, coding, and collections systems, including two years of experience supervising staff performing billing, coding, and collections activities, and a bachelors degree in business, public administration, management, or other related field. Other combinations of experience and education that meet the minimum requirements may be substituted. CPB, CPC or better required.