Supervises and participates in activities in professional billing in Patient Billing Services. Plans, controls, and implements departmental policies and procedures to effect orderly flow of third party payer bills and other work assignments. Interacts with clinic and contract physicians as necessary. Participates in quality assessment and continuous quality improvement activities. Ensures compliance of all appropriate safety and infection control standards. Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior. Works under general supervision of the Assistant Director for Professional Billing or designee who reviews works for compliance to established policies, procedures, and standards. Exercises full supervision over personnel engaged in billing activities and maintenance of related records.
Responsibilities
- Supervises, coordinates, and participates in regular, ongoing billing operations and activities. Reviews and processes clinic and contract physician billing.
- Develops, monitors, and ensures adherence to policies and procedures to accomplish agreed-upon departmental objectives and maintain efficient billing productivity standards.
- Develops staffing and work schedules for billing personnel. Approves leaves, vacations, personal days, and overtime. Computes and signs time cards.
- Evaluates and provides recommendations regarding hiring, progressive discipline, and/or discharge of subordinate employees. Monitors and evaluates work of billing personnel. Participates in performance reviews. Handles grievances at first step.
- Assists in orientation, training, and in-service/continuing education of physician billing personnel.
- Prepares and assigns work as necessary to ensure equitable bill distribution and efficient billing productivity. Assures compliance with billing productivity standards through use of daily production records.
- Initiates prompt follow up action on accounts already billed to third party.
- Maintains and controls requests for billing information from physicians and Medical Center administration. Interacts with computer service company and balances electronic charge and payment reports.
- Analyzes billing errors and recommends corrective action. Works closely with professional billing personnel to ensure prompt payment in all areas.
- Ensures efficient, effective, and increased use of electronic billing to and electric payment from third party payers.
- Acts as liaison between billing, medical records, service access management services, and information technology.
- Interacts with physicians as required to resolve third party concerns and keeps all parties informed of current billing activities.
- Compiles and maintains monthly department reports including management reports regarding collections, billings, productivity and performance standards. Distributes to contract physicians, Research and Education department heads and administration as appropriate.
- Collects information and processes applications for third party payer enrollment for initial and subsequent credentialing cycles. Maintains appropriate records, files, and logs and utilizes computer for access, input, and retrieval of pertinent information.
- Handles initial and follow-up inquiries regarding third party applications and enrollment.
Qualifications
- High School Diploma or GED.
- Five (5) years of experience in inpatient and outpatient, computerized and manual physician billing for both physician and non-physician practitioners and third party carriers utilizing a 1500 claim form and/or 1500 electronic billing procedures/methods in a professional office or multi-practice setting. An Associate degree in Business Administration, Health Care Administration, Medical Insurance Specialist or related field with at least eight (8) semester or twelve (12) quarter credits in Accounting may substitute for two (2) years of the required experience. A Bachelor's degree in Business Administration, Health Care Administration, Medical Insurance Specialist with at least eleven (11) semester or sixteen (16) quarter credits in accounting may be substituted for three (3) years of the required experience.
- Incumbents appointed to this classification must be certified by the American Health Information Management Association or the American Association of Physician Coders as a Certified Coding Specialist-Physician Based (CCS-P) and/or Certified Professional Coder (CPC) within six (6) months of date of appointment. Failure to obtain and maintain required certification shall be grounds for termination.
- Demonstrated knowledge in medical terminology, anatomy, physiology, and coding classification systems (ICD-9-CM, CPT, HCPCS).
- Demonstrated knowledge of Medical Center computer systems (e.g., Advantae, SMS, MRIS, Medifax/HDX, DENIS, PHO referral).
- Knowledge of inpatient and outpatient professional billing regulatory requirements for third party carriers.
- Knowledge of documentation requirements for professional billing.
- Knowledge of fee for service and capitation payment methodologies and CCI edits.
- Knowledge of accounts receivable control and general credit policy.
- Demonstrated ability to problem solve and to use conflict resolution techniques.
- Ability to understand and analyze accounts receivable management-related reports.
- Ability to analyze and interpret data.
- Ability to develop electronic spreadsheets.
- Ability to organize and coordinate daily assignments independently.
- Ability to communicate both orally and in writing.
- Ability to establish and maintain effective working relations with administration, department heads, co-workers, subordinates, physicians, other Medical Center employees, patients, and the general public.