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Insurance & Reimbursement Manager

April 28, 2014 - December 31, 2015
Location:Greenville, NC
Exempt/Non-Exempt:Exempt
Benefits:Health, Dental, 401K, PTO and more
Employment Type:Full Time
Department:Midlevel Managerial
Description:Coordinates the day-to-day billing and reimbursement business operations of the practice. Oversees accounts receivable functions, claims submission, payment posting, insurance and accounts receivable follow-up, and reimbursement management. This position has the responsibility of Electronic Practice Management (EPM) Administrator.

SUPERVISION EXERCISED: Manages and oversees the insurance and billing department in their daily duties and activities.

TYPICAL PHYSICAL DEMANDS: Work is performed in an office environment with constant interruptions. Sedentary work in front of a computer screen is required on a daily basis. The position requires extreme concentration to specific details to avoid costly errors. Travel to different locations and PODs is required.

TYPICAL WORKING CONDITIONS: Normal office environment.
Duties:• Manages insurance and billing services on a daily basis to ensure timely and accurate handling of all patient accounts including third party insurance claims; processing of remittance advices, patient statements and invoices.

• Maintains established insurance and billing department protocols, policies, procedures, objectives, quality assurance, safety and environmental controls. Develops insurance and billing department protocols, policies, procedures, objectives, quality assurance, safety and environmental controls as needed.

• Ensure the activities of the Billing Office are conducted in a manner that is consistent with overall department protocols, in compliance with federal, state and payer regulations, guidelines, and requirement.

• Manages insurance and billing supervisor efforts to hire and train staff, evaluate staff performances and take personnel actions as designated to include changes in job functions and disciplinary action. Monitors the assigning of work and workflow. Establishes priority for insurance and billing supervisor as needed. Manages training of employees to include organizing, prioritizing and scheduling work assignments.

• Monitors reimbursement profiles from third parties and compares this data to the practice’s fees. Reviews annual fee survey with the purpose of comparing and matching fee with codes.

• Prepares the annual analysis of Medicare assignment and other special projects as assigned.

• Manages the maintenance of Medicare allowable and monitors billing to ensure compliance with frozen fees.

• Manages charges for billable supplies and ensures the proper markup is implemented.

• Remains current on all changes in legislative regulations that affect the reimbursement area.

• Serve as principal liaison with staff and administrative team on day-to-day issues within the areas of Billing Office operations.

• Provide advice and assistance to senior management in the planning, implementation and evaluation of modifications to existing operations, systems and procedures.

• Monitor write-offs/denials with the objective of minimizing losses.

• Coordinate with Accounting on A/R, unclaimed property, drug study accounts undeliverable checks and other duties as necessary.

• Ensure payment received for all services is allocated properly.

• Actively pursue all non-payments identifying the cause and providing a corrective solution.

• Prepare and deliver all reports as directed.

• Monitors A/R and respond to problems as needed.

• Maintains the tables and information in the practice management system that supports patient and insurance billing.

• Effectively manages the timely response of billing inquiries and insurance follow-up.

• Works with vendors; EPM, statement and clearinghouse to accomplish duties and solve billing problems.

• Oversees practice’s collection programs. Monitors and evaluates program effectiveness and progress and works to implement changes. Acts as the liaison with the collection agency and monitors performance of agency.

• Handles patient complaints about fees and billing and decides upon the disposition of these complaints.

• Handles complaints and quality requirements relating to billing department function from insurance carriers and other 3rd party payers and decides upon resolution strategies for these complaints.

• Works as liaison with other departments to facilitate problem solving and data collection appropriate to patient and insurance billing.

• Ensures that all billing and collection activities meet and adhere to Medicare and Medicaid and other insurance regulations, rules and laws.

• Effectively communicate information, policies and/or procedures in a manner easily understood.

• Update fee schedules and other as needed in relation to billing.

• Analyze trends effecting charges, collections and accounts receivable and take appropriate action to realign staff and revise procedures.

• Analyze reports and perform audits to determine areas of improvement and determine appropriate plan of action.

• Maintain up-to-date library of information/tools related to documentation guidelines and coding.

• Responsible for day end, month end, and year end computer A/R applications processing as scheduled.

• Other duties as assigned.

• Attend and participate in facility meetings as requested.

This job description in no way states or implies that these are the only duties to be performed by this employee. He or she will be required to follow any other instructions and to perform any other duties requested by his or her supervisor.
Qualifications:EDUCATION/EXPERIENCE:
• Requires Bachelor’s degree in Business or closely related field.

• Five years or greater experience in healthcare including two to three years of management experience.

• Strong analytical and organization skills required.

• Ability to develop and provide high quality in-service and seminar of insurance reimbursement, collections and A/R related topics.

• Knowledge of third party and insurance procedures, regulations and billing requirements, and government reimbursement programs.

• Have strong ability to lead and or work as a member of various cross-functional teams.

• Well-developed written and oral skills. Understanding of customer service principles.

• Must have strong software skills including knowledge of Word, Excel, etc. Demonstrated proficiency with software applications such as NextGen, Centricity and/or related.

• Ability to read small print such as found in contracts, terms and conditions.

Key Skills and Personal Characteristics:
• Ability to form positive and collaborative relationships with all levels in the organization.

• This position requires strong organizational and excellent communication skills as well as being highly motivated and detail oriented.

• Possess the ability to identify gaps or problems in business processes and develop ideas to resolve them.

• Must have a strong sense of team commitment, which includes meeting deadlines, punctuality and excellent follow-through and feedback.

• Must display a high level of integrity and initiative.

• Ability to perform research and understand complex regulatory documents and legal language.

• Strong relationship building skills with the ability to delegate and mentor.


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