Job Description

TITLE:                           BILLING SUPERVISOR

POSITION SUMMARY: Supervises, plans, implements and oversees the system-wide activities related to filing of all claims on both UBs and 1500 forms including claims that require invoices and/or repo1is. References direct data entry (DDE) for verification of beneficiary's name for Medicare claims. Communicates reoccurring billing errors to Director of Billing through weekly and monthly reports along with rec01mnendations 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 submitted for payment. Interact with O1m1i 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 and benchmark repo1is on physician and department billing performance.

Job Duties:

THE FOLLOWING ARE ESSENTIAL JOB ACCOUNTABILITIES:

1.    Supervises the submission of electronic and paper claims daily & monthly patient statements. Through billing staff provides feedback to physician practice staff on data and demographic corrections. Coordinate with health center managers and Omni Family Health staff to maintain expected daily submission benchmarks for AR collections, closed claims, clean (first pass rate 95%) and bad debt rates (< 5%). Reconciles multiple billing systems and interfaces, including rejections to ensure timely billing. Inform quality review (QR) when additional training needs are identified that will assist billing and front office staff with issues related to clean claim submission, patient registration or other EPM maintenance concerns. Interviews, hires, and disciplines staff as necessary.

2.     Perform EDI enrollment of new and existing providers to managed services. Process daily DSG requests and receipts to reconcile to patient accounting system submissions and adheres to regulatory guidelines for timely submission and reprocessing. Oversees the submission and receipt of 837, 835 files between Omni Family Health and outside vendors.

3.    Reviews and analyzes clinic level reports to ensure all scheduled services have charges updated within department guidelines. Verifies the accuracy and timeliness of billing activities, problems and trends. Works with support personnel to develop effective reporting and diagnostic tools.

4.     Identify and work with all departments to correct potential problems from all phases of the billing process including scheduling, authorization and verification, registration, charge processing, coding, denials and follow up.

5.     Various other work-related duties as assig ne d 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.

Additional Duties

1.     HIPAA compliance - Responsible for enforcing 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 to learn and use the Electronic Health Record and Practice Electronic System and its components as required by the job functions and highlighted in the Policies and Procedures.

5.      All employees will participate in Patient Centered Home Health Model at Omni Family Health.

Qualifications, Education, and Experience

Education:

1. High school graduate with three years of medical billing and accounts receivable experience.

Experience:

1.      Three (3) years of billing and accounts receivable experience or

2.       Two (2) years of Supervisor experience preferred, 5 years of billing experience if not supervisory experience

Skills:

1.     Ability to operate computers, Microsoft operating system and provide direction to staff as needed.

2.     Must be able to take responsibility and work under pressure.

3.     Basic knowledge of CPT and ICD 10 codes.

4.     Ability to work under pressure and handle multiple functions.

5.     Knowledge of community based organization s.

6.     Ability to communicate with the providers and medical/dental providers and staff.

7.     Promotes and believes in OMNI mission statement.

8.     Ability to work proficiently and effectively within a timely manner.

9.     Knowledge of account receivable processes, payor codes, and other bookkeeping functions.

Responsible to: Classification:

Director of Billing Full-time, Exempt