Supervises, plans, implements and oversees the syste m-wide activities
related to filing of all claims on both UBs and 1500 forms including cla ims that require invoices and/or reports. References direct data entry (DDE) for verificat ion of beneficiary’s name for Medicare claims. Commun icates reoccurring billing errors to Director of Billing through weekly and monthly reports along with recommendations for solution. Supervise staff in the performance of denial management , claims processing, statement submission and monthly statistics of overall performance. Maintains satisfactory clearinghouse and system level error rates and ensures the accuracy of claims being submi tted for payment. Interact with Omni Family Health’s Health Center Managers and other business office staff in order to facilitate education required to reduce error rates when necessary. Prepares monthly analysis a nd benchmark repo rts on physician and department billing performance.
The following are essential job accountabilities:
- Supervises the submission of elect ronic a nd paper claims daily & monthl y patient
statements. Through billing staff provides feedback to physician practice staff on data and
demographic correctio ns. Coordinate with healt h ce nter managers and Omni Family Health staff to maintain expected daily submiss io n benclmrnrks for AR collect ions, closed claims, clean (first pass rate 95%) and bad debt rates (< 5%). Reconciles multiple billing systems and int erfaces, including rejections to ensure time ly billing. Info rm quality review (QR) when additional training needs are identified that will assist billin g an d front office staff wit h issues related to clean claim submission, patient registration or other EPM maintenance concerns. Interviews, hires, and disciplines staff as necessary.
- Perform EDI e nrollm ent of new and existing providers to manag ed services. Process
daily DSG request s and receipts to reco ncile to patien t accounting system submissions and adheres to regulatory guidelines for timely submission and reprocessing. Oversees the submission and receipt of 837, 835 files betwee n Omni Family Health and outside vendors.
- Reviews and analyzes clinic level repo rts to ensure all scheduled se rvices have charges updated within department guide lines. Verifies the accuracy and timeliness of billing activities, problems and trends. Works with support personne l to develop effective reporting and diagnostic tools.
- Identify and work with all departments to correct potential proble ms from all phases of the billing process including sched uling , authorizat ion and verification, reg istra tion, charge processing , cod ing, denials and follow up.
- Various other work-related duties as assigned by supervisor. These duties and
responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
- HIPAA compliance – Responsible for enforcing compliance with all HIPAA regulations and requirements. Treats all member information confidential.
- Compliance – Ensure compliance with all local, state, and federal regulations.
- QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- IT – Required to learn and use the Ele ctronic Health Record and Practice Electronic System and its components as required by the job functions and highlighted in the Policies and Procedures.
- All employees will participate in Patient Centered Home Health Model at Omni Famil y Health.
Qualifications, Education, and Experience
I. High school graduate with three years of medical billing and accounts receivable experience.
- Three (3) years of billing and accounts receivable experience or
- Two (2) years of Supervisor experience preferred, 5 years of billing experience if not supervisory experie nce
- Ability to operate computers, Microsoft operating system and provide direction to staff as needed.
- Must be able to take responsibility and work under pressure.
- Basic knowledge of CPT and ICDl0 codes.
- Ability to work under pressure and handle multipl e functions.
- Knowledge of community based organizations.
- Ability to communicate with the providers and medical/dental providers and staff.
- Promotes and believes in OMNI mission statement.
- Ability to work proficiently and effectively within a timely manner.
- Knowledge of account receivable processes, payor codes, and other bookkeeping functions.
Responsible to: Director of Revenue Cycle
Classification: Full-time , Exempt