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Director of Billing

Position: Director of Billing
Contact: Janet Day
Contact Email: [email protected]
Type: Full-Time
Categories:
Overview:

·       Liaison between clinics, physicians and billing team

·       Compliance with all legal requirements and ethical standards is a continuing obligation of employment with the group.

·       Provide billing support to Management and Operational staff by staying abreast and communicating state, federal, and payor insurance regulation updates.

·       Ensure claims are filed with appropriate CPT, ICD-9, & Modifiers

·       Review processes & monitor rejections from carriers, resubmission of claims for reimbursement, payment posting, and filing appeals according to departmental policies and procedures. Assist as necessary.

·       Ensure the timely filing and collections according to guidelines

·       To review and assist in sending collection letters to patients monthly.

·       Answer and handle escalated account calls concerning patient and insurance balances, insurance changes, patient information updates, and refiling insurance information in an efficient and timely manner.

·       Monitor & assign credit balances to staff

·       Uses data analytics to review coding trends and provide feedback to Physicians, Administration, and Accounting

·       Other duties as assigned by Physicians or Management

 
 
Daily Monitoring:

·       Incoming mail payments, open and distribute accordingly

·       Prepare daily credit card report

·       Establishes / monitors check in process, ensures capture of all necessary information for immediate billing

o   Insurance / demographic information and verification, co-pay collections and payment on accounts

·       Establishes / monitors charge entry process for accurate and timely filing

·       Monitors payment posting for accurate and timely posting

·       Establishes process / monitors Accounts Receivables

o   Makes changes to policies and procedures as necessary

 
Monthly

·       Establishes appropriate process to close month end

·       Reconciliation of Accounts Receivable, Collections, Bank Account, Credit Balances, Charges by provider and location

·       Prepares month end reports

·       Analyzes data for trends and makes recommendations for improvement and increased efficiencies

·       Create front end scorecards and facilitates monthly meetings with offices to improve front end processes

·       Prepares and distributes physician report cards

 
 
Human Resource Management
Responsible for the recruitment and oversight of the billing staff to ensure days in AR & cash flow are maintained.
 
Oversight

·       Ensure claims are filed with appropriate CPT, ICD-9, & Modifiers

·       Review claim notes to ensure there is appropriate documentation for claims by staff.

·       Review claims submission batches and reconcile

·       Ensure rejections are worked and resubmitted for reimbursement to meet monthly goals. 

·       Ensure patient and insurance payments are appropriately and timely posted. 

·       Ensure adjustments are posted per group policies

·       Review account balances with carriers and ensure staff are resolving appropriately for reimbursement using delinquent claims report

·       Review for timely filing and collections according to insurance billing & collection guidelines

·       Monitor for monthly collection letters

·       Monitor processes for handling return checks, bad addresses and return mail for the practice.

·       Monitor the handling of account calls concerning patient and insurance balances, insurance changes, patient information updates, refile insurance information, and etc. in an efficient and timely manner by staff.

·       Ensure credit balances for refunds due to the patient or the insurance company are processed

 
Recruitment

·       Assess Department needs to make recommendations to appropriate staffing levels

·       When needs arise, communicates with Administration to place ads where necessary to recruit appropriate employees.  Reviews resumes / applications

·       Conducts interviews

·       Makes recommendations for hiring & salary 

·       Conducts phone reference checks

·       Verifies credentials (if necessary)

·       Works with Administration for new hire orientation

 

               Employee Review Periods

·       All new employees have an initial employment period of four (4) months for hourly employees or six (6) months for salaried/management employees. Will provide a work review to the employee at the end of the initial probationary employment period

·       Facilitates yearly reviews for billing employees

o   Monitors timeframe

o   Solicits comments from providers

o   Recommends salary adjustments accordingly

 
Payroll

·       Reviewing PTO requests, approving / denying while ensuring appropriate staffing levels

·       Managing PTO balances

·       Approve timecards each pay period

 
IT Management

·       Maintains working relationship with external IT consultant to ensure highest possible IT efficiencies

·       Maintains working relationships with IT support departments for all software / hardware vendors as necessary

·       Notify IT company of new hires to obtain windows login and email address

·       Set up new hires in Practice Management System and EMR

·       Assess IT needs

·       Facilities orders as necessary (Computers, scanners, printers, etc.) upon Administrator approval.


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