Position Summary:
We have an exciting opportunity to join our team as a Billing Representative III.
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Manage all aspects of charge submission, coding review, accounts receivable, authorizations, or customer service processes and assigned workqueues/teams. Provide financial and/or operational analyses and reports, and audit current procedures to monitor and improve efficiency of operations. Review and advise physicians and staff with regard to local and national coding and reimbursement policies. Work with patients and guarantors to clarify financial responsibilities as necessary as a part of the revenue cycle team.Job Responsibilities:
- Manage a team responsible for performing important revenue cycle functions.
- Directly supervise billing employees, establish priorities, assign work, and follow up to ensure assignments are complete. Select, orient, and evaluate staff. Provide initial and ongoing guidance. Resolve employee issues and address procedure and performance related issues.
- Meet or exceed internal standards for accuracy and timeliness in charge documentation preparation and submission.
- Compile statistical data as requested and reports data monthly to appropriate parties. Prepare reports and analyses to assist in identification of cash flow variances, physician referral patterns, physician volume, and any other issues identified by Management.
- Review outstanding accounts receivable to maintain minimal level of open accounts.
- Determine and establish the explanation to complex claims, issues, and questions not covered by specific instructions or common practice.
- Demonstrate a significant level of expertise in subject matter to assist and mentor entry-level billing staff, support the operations lead/supervisor in managing day-to-day team activities against scope and timeline, and ensure timely reporting of activities. Provide feedback and contribute to employee performance reviews.
- Identify denial trends and train staff accordingly to avoid in the future, emphasizing improvement of accurate charge capture. Develop supporting training documentation as needed with FGP management.
- Serve as a liaison to the outside billing for questions, data request, and other inquiries. Review charge encounter forms for complete CPT code, ICD-10 code, and other required billing information on a daily basis.
- Ensure timely and accurate collection, preparation, and verification of billing information submitted. Review billing collection and denial reports from the vendor and identify trends and recommend changes on how to improve issues.
- Work with practice operations to implement changes to improve revenue where necessary.
- Take initiative to teach and share new information and provide constructive feedback; Communicate delays and workqueue issues to management daily.
- Review practice Action Plans and/or reports on a timely basis. Analyze issues to identify trends in denial rates to focus improvement initiatives on, and charges that requires action.
- Review unbilled charge reports and follow up with physicians and/or practice management for unbilled services as needed.
- Adhere to general practice and FGP guidelines on compliance issues and patient confidentiality.
- Collaborate with coders to understand CPT and ICD-10 manuals, payer policy and procedure manuals, updates, and CMS publications to ensure practices are compliant with current policies and procedures.
- Serve as resource to physicians, staff, and management regarding reimbursement policies. Educate physicians, staff, and management on new policies and changes to existing policies.
- Review and respond to practice, physician, and patient inquiries following CBO guidelines/pathways.
- Work with front-end staff to ensure patient insurance information and benefits are verified accurately and timely. Act as a resource to front end practice staff to identify gaps in clearance processes.
- Interact with vendors as it relates to billing and collections.
- Identify issues and suggest improvements and available tools to physicians and admin support staff to address issues. Escalate issues as needed to practice and FGP Leadership.
- Monitor reports and workqueues, ensuring charge submission and accounts receivable follow-up is occurring on a timely basis.
- Implement and manage a quality control program for individual coders, provide feedback to staff to maximize productivity, ensure accuracy of claims, increase revenue, and/or provide world-class customer service.
Minimum Qualifications:
To qualify you must have a Bachelors Degree with a minimum of 5-7 years of relevant work experience or equivalent combination or training and relevant work experience. Ability to handle multiple tasks at once; good communication, interpersonal, and computer skills. Arrive on time for work and meetings. Ability to develop and maintain effective working relationships with staff and patients. High level of accuracy for reviewing charge batch submissions, preparing and presenting analyses, and in staff education. Maintain current insurance regulatory policies and requirements relevant to the specialty. Knowledge of medical terminology required. Familiar with standard office equipment.
Required Skills
Required Experience
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