Director of Billing



Location:   Fiscal - Bakersfield Corporate                     Job Summary:    This position manages and oversees the Billing Department. The Director of Billing is responsible for maximizing the productivity and minimizing the errors of the Billing Department using structured auditing and reporting methodologies combined with follow-up training of staff. The Director of Billing will assume a strategic and practical role in the billing department to include day-to-day responsibility for billing processing and strategy, planning, management and analysis, and policy development and ensuring that processes are in accordance with Omni Family Health (OFH) policies and procedures and funding and regulatory agencies rules and regulations.  This position reports to the Chief Financial Officer/Controller  Job Duties:                
  1. Responsible for all aspects and management of the OFH revenue cycle. Oversees the timely and accurate billing of OFH services to payer sources to ensure maximum revenue capture.
  2. Establishes internal controls to ensure that area meets performance goals to include, cash, A/R days, production by area, and denial reduction.
  3. Responsible for monitoring daily cash flow.
  4. Oversees and manages claim aging to ensure that corrected claims are then reprocessed to ensure maximum revenue reimbursement.
  5. Will make adjustment and reports for claims that have aged out and not collected will provide comprehensive report on written off claims to the CFO/Controller and Executive Leadership Team.
  6. Responsible for productivity of billing staff. Daily review/maintain the accuracy of all posting of route slips for the billing process/statements.
  7. Maintain accurate records as required for each program such as Family PACT program, to include all required financial statistical data, which may not be produced electronically.
  8. Review and verify medical coverages of payer sources and other agencies.
  9. Will work with the CFO and Controller to determine if payer source application is appropriate given reimbursement rate versus health center costs. Works on ensuring capitation rates are reasonable for organization.
  10. Responsible for monitoring changes in the healthcare industry affecting the billing and collection efforts of the health center.
  11. Work with Information Technology and operational leadership to identify E.H.R. related workflow issues that can decrease the effectiveness of the revenue cycle process. Make recommendations to help implement solutions.
  12. Perform the analysis and review of payments received including EFT to ensure appropriate payments are received and adjustments are made accordingly.
  13. Acts as a resource to billing staff for problem solving difficult accounts; information system issues; monitors training and provides general guidance regarding workflow processes. Ensures that problem solving occurs at the lowest level possible with positive outcomes.
  14. Responsible for ensuring the continued development, supervision and management of all billing personnel.
  15. Ensures that billing personnel are trained and are updated to all changes in billing regulations and processing and that they do their jobs effectively and efficiently.
  16. Works closely with other areas of health center departments (e.g., Operations, Medical, etc.) to ensure that personnel are adequately trained on revenue cycle expectations.
  17. Works closely with Human Resources’ Credentialing area to ensure communication and work process mesh and that both areas support the work of the other.
  18. Completes scheduled performance evaluations and education requirements of assigned patient financial Services staff.
  19. Supervise maintenance set of posting (charges, receipts, adjustments, payor codes, statistical information, procedures, and diagnosis) for proper billing and reports.
  20. Provides regular reports to the CFO/Controller and Executive Leadership Team.
  21. Responsible for the overall service provided by the team when answering patient’s questions regarding services, statements, etc.
  22. Review the closing of the month and run all reports needed and as required by regulations and funding agencies. Not to exceed the 10th of every month.
  23. Other related duties as required by the CFO/Controller.
Additional Duties:
  1. HIPAA compliance - Responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements. Treats all member information confidential.
  2. Compliance - Ensure compliance with all local, state and federal regulations.
  3. QA/QI - Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
  4. IT - Required learning and using the Electronic Health Record and Practice Electronic System and its components. As required by the job functions and highlighted in the Policies and Procedures. These components include NextGen, PMS, QSI and other electronic features, as they are developed and implemented, as applicable to work environment.
  5. All employees will participate in Patient Centered Health Home Model at Omni Family Health.
  1. Must be a self-starter and able to work under pressure and handle multi-functions.
  2. Analytical with ability to determine critical areas to address as well developing appropriate approach to solution.
  3. Effective communicator
  4. Ability to establish and maintain effective working relationships across the health center.
  5. Excellent customer service and public relations skills.
  6. Knowledge of CPT/ CDT and ICD9 codes and HCPS coding.
  7. Knowledge of all programs offered and payer codes available in OFH.
  8. Knowledge of sliding fee schedules.
  1. Ability to relate to the public regardless of ethnic, religious and economic status.
Qualifications, Education, and Experience:
  1. Bachelor’s degree in business or health management, or related field preferred. Experience can be substituted for education.
  2. 5 - 8 years billing experience with minimum of 5 years overall billing leadership experience. Experience working in a federally qualified health center environment preferred.
  3. Certification in at least one of the following: Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician-based (CCS-P) or Certified Professional Biller (CPB) and/or Certified Medical Reimbursement Specialist (CMRS) credentials.
  4. Experience with working in an integrated health care system required; NextGen preferred.
  5. Must have experience and be A/R oriented, daily and monthly closings, and understand
  6. Demonstrated knowledge of all insurance companies, HMO's, PPO's, Medicare, Worker's Comp, third party payers. 
Responsible To:         Chief Financial Officer/Controller Classification:            Full Time Position, Exempt