Responsibilities:
Ensures accurate and timely billing of physician claims, including by overseeing claim preparation, resolving claim edits, and conducting charge review as necessary.
Monitors key performance indicators, productivity, and quality of individual staff and full department efforts through regular reporting.
Manages billing processes (e.g., by overseeing use of software and other tools in workflows) to support accounts receivable levels consistent with national averages and administrative expectations (e.g., A/R over 90 days, net A/R for all payers, cash collections).
Oversees insurance follow-up, including reviewing statuses of pending claims, supporting denial team with necessary research, and correcting rejected claims to be rebilled.
Completes reconciliation and month-end reports promptly and correctly.
Tracks issues with payers to be resolved and identifies common themes in communication that can be used to improve internal workflows and potentially to guide productive and beneficial conversations contract negotiations.
Demonstrates understanding of all state and federal regulatory requirements for billing patients and both government and commercial payers to ensure compliance and appropriate reimbursement.
Possesses knowledge of payer contracts to meet all billing requirements for third-party payers.
Works independently while referring major challenges to the director of patient financial services.
Directs supervisory staff of data entry, charge capture, and commercial and government follow- up teams.
Responsible for interviewing and hiring staff, managing performance reviews, and implementing necessary disciplinary action.
Oversees staff orientation, ongoing training and development, and work assignments.
Develops and implements best practices in billing and follow-up processes with the aid of clinic and physician practice leaders and director of patient financial services.
Provides an effective, professional environment that meets or exceeds the expectations of One Beebe, patients, and payer representatives.
Coordinates communication between revenue cycle departments and other departments as necessary.
Evaluates and responds to organizational and patient needs to ensure internal and external customer satisfaction.
Aids in tracking qualitative and quantitative key performance indicators at the physician practice level, as well as conducting root cause analysis to determine the source of performance issues .
Assists in the planning of improvement initiatives and the implementation process; coordinates improvements with departmental leadership as necessary.
Examines current physician practice processes to ensure continued compliance with changing guidelines and best practices, and modifies policies and procedures as necessary.
Acts as staff resource and has the ability to provide guidance on processes within all physician practice revenue cycle areas.
Stays apprised of all relevant regulations, standards, and directives from regulatory agencies and third-party payers.
Carries out other assignments or special projects as directed.
Monitors professional revenue cycle processes and identifies areas in need of improvement.