CLASSIFICATION: Billing and Accounts Receivable Supervisor
Pay Grade: $75,690.46 - $98,034.60 Annually
POSITION SUMMARY:
Under the general supervision of the Finance Manager, has the primary responsibility for the Saginaw County Community Mental Health Authority revenue cycle. Plans, implements, and manages departmental policies and procedures to effect orderly flow of the billing and reimbursement process. Assists in implementation of new programs as related to the reimbursement and revenue component. Participates in quality assessment and continuous quality improvement activities. Performs related work as required. This position will be knowledgeable about and actively support culturally competent recovery-based practices; person centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid persons served in the recovery process.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Supervise billing and coding staff to assist with the revenue cycle functions.
2. Manage the set-ups of all electronic billing systems to ensure proper functioning for effective and efficient billing and reimbursement processes.
3. Ensure timely monthly close of the billing function.
4. Analyzes account detail (charges, payments, adjustments) and answers detailed questions from Billing & Accounts Receivable Specialists and Insurance Coding and Compliance Specialists.
5. Assists Billing & Accounts Receivable Specialists with identifying and providing solutions for third party denials to obtain proper reimbursement of services.
6. Reconcile and monitor receivables and revenue between the General Ledger and SENTRI (EMR) to ensure accuracy and timely resolution of discrepancies.
7. subsidiary records with general ledger control accounts
8. Prepare and distribute end of month management reports.
9. Create monthly revenue journal entries based on EMR (SENTRI) service activity.
10. Serve as the primary Finance liaison for the SENTRI (EMR) system, coordinating system enhancements, managing change requests, and resolving application issues.
11. Serve as the Finance contact to the SCCMHA Entitlements Department regarding financial determinations (third-party payers, ability to pay, Medicaid deductibles) for individuals served within the SENTRI (EMR) system.
12. Plan and implement quality assurance for all billing processes.
13. Provide personnel development at staff and clinical provider meetings.
14. Develop and implement best practices for the billing department.
15. Develop and oversee procedures for the verification of service coding accuracy.
16. Develop, implement, and oversee procedures for the review, appeal, and resubmission of all claim denials.
17. Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations and follow agency HIPPA reporting requirements.
18. Assists medical providers and employees with guidance on the usage of a specific CPT code, and modifier or documentation requirements.
19. Manage the reconciliation of all discrepancies found in billing records in a timely manner and provide reports to management or outside entities as appropriate.
20. Compile requested statistical, financial, billing or auditing reports using Excel functions and pivot tables.
21. Assists in compiling and evaluating documentation requested by external auditors related to the Authority's revenue cycle.
22. Develop, implement, and oversee procedures for the posting of all 3rd party payments received and the reconciliation of identified differences.
23. Work with SCCMHA credentialing staff and Insurance Coding & Compliance Specialist to coordinate and manage the clinical provider credentialing process with all outside entities.
24. Handle routine correspondence and other administrative tasks as required.
25. Identifies specific risk coding areas and strategies to promote accuracy and compliance, detection and correction of potential risk exposures and report these findings directly to the Finance Manager.
26. Provides and maintains current technical knowledge of insurance regulations pertaining to claims processing, coding, and allowable rates that can be billed and paid for by insurance carriers, and/or other programs to the extent that provides a level of understanding for managing the reimbursement function in a way that maximizes revenue and prevents untimely rebilling of routine services.
27. Responsible for analyzing and updating provider fee schedules in SENTRI (EMR) and coordinating with Network Services, as necessary.
28. Attends periodic conferences to maintain professional certifications as needed.
29. Serve as administrator for all third-party billing systems (ex. CHAMPS, Availity, Trizetto, CMS, etc.)
30. Assist with documenting financial policies, procedures, and detailed work instructions.
31. Performs other duties and responsibilities as assigned by supervisor.
32. Communicates the mission, vision, core values, and operating principles of SCCMHA to finance staff while holding them accountable and implements these principles in all duties of this position.
INCIDENTAL DUTIES AND RESPONSIBILITIES:
1. Serves all persons served with respect and dignity.
2. Communicates well with persons served, co-workers, and supervisors and meets deadlines and follows through with others as promised in order to provide additional information and/or to answer questions.
3. Demonstrates the ability to provide exceptional customer service to all persons served, staff, and providers of service.
4. Obtains necessary computer training in order to stay current with system changes, as needed to complete all tasks related to this position.
5. Attends meetings, seminars and workshops and studies periodicals or publications in order to maintain proficiency in this area and to sustain or improve level of knowledge needed to coordinate changes to the billing system or reimbursement procedures.
6. Maintains a professional office setting at all times and organizes workflow in an effective and
efficient manner.
(The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all duties and responsibilities required of personnel so classified.)
REPORTING RELATIONSHIPS:
Reports to: Finance Manager
Supervises: Billing and Accounts Receivable Specialists, Insurance Coding and Compliance Specialist
WORKING CONDITIONS/ENVIRONMENT:
Works in professional managed healthcare office environment with pressures of time periods of time, which requires extensive viewing of monitor screens. Frequent and continuous use of computer keyboard. Occasionally will be required to drive personal automobile. Varied and extra hours may be needed to complete assignments.
QUALIFICATIONS:
Education: A Bachelor's degree in Business Administration, Accounting, Finance or a directly related field is required. Specialized certification (RHIT, RHIA, CPC, COC, CCS, etc.) is desired.
Experience: Two (2) years of supervisory experience is required. Two (2) years of relevant billing/coding experience is preferred.
Licenses and Credentials: Valid Michigan Driver's License with good driving record. Specialized certification (RHIT, RHIA, CPC, COC, CCS, etc.) desired.
Knowledge, Skills, and Abilities:
1. Knowledge of and ability to use computerized accounting software such as
Business Central.
2. Proficiency in Microsoft Office such as Word, Excel, Access, and Outlook.
3. Comprehensive knowledge of the billing process working with an Electronic Medical Records Healthcare System.
4. Experience in identifying and resolving billing and reimbursement issues.
5. Knowledge of medical terminology and medical procedures associated with
clinical billing codes.
6. High degree of attention to detail.
7. Skilled in normal office procedures such as written and verbal
correspondence and use of calculator and other office machines.
8. Ability to communicate effectively with others and occasionally deal with
irate individuals.
9. Ability to diplomatically associate and relate to individuals of all social, economic, and cultural backgrounds.
Physical/Mental Requirements:
1. Hearing acuity to converse in person and on telephone.
2. Visual Acuity to read and proofread documents and use CRT for extended periods of time.
3. Ability to walk, stand or sit for extended periods of time.
4. Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)
5. Ability to lift and carry files and supplies at least 20 pounds.
6. Strong interpersonal skills to interact with leadership, employees, persons served and the general public.
7. Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action.
8. Ability to plan short and long range and to manage and schedule time.
9. Ability to handle stress in meeting deadlines and dealing with large numbers of employees and/or persons served.
10. Ability to handle mental and physical stress of recipient interaction, meeting deadlines and handling administrative problems.
(Listed qualifications are for guidance in filling this position. Any combination of education and experience that provides the necessary knowledge, skills, and abilities will be considered; however, mandatory licensing or certification requirements cannot be waived. Physical/mental requirements cannot be waived unless specifically indicated.)
