Lead Medical Billing and Collections

Job Code: LMBC - 112

Starting Salary: $19.52 hourly; $40,606 annually
FLSA: Exempt

Overview

We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.

General Description

The purpose of this position is to provide support to staff regarding billing, timely submission of electronic and/or payer claims, monitoring claims status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care Organizations (MCO's), and Commercial insurance payers in EHN's electronic health record. This position must possess leadership skills, critical thinking skills and thorough understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to train new team members and answer any billing related questions the team may have. In addition, this position must demonstrate proficiency with billing systems to ensure all functionality is utilized for the utmost efficient processing of claims. The Medical Billing and Collection Specialist Team Lead shares responsibility for the overall management of the Revenue Cycle Department. Lead will maintain and create policies and/or procedures as necessary related to the core tasks of the Revenue Cycle Department.

This class works under general supervision, independently developing work methods and sequences. This position will report directly to the Chief of Revenue Cycle. All Reimbursement Specialist will report to this position.

Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position as necessary.

• Assist with staff recruitment, scheduling, placement, directing and evaluating assigned staff, processing employee concerns and problems, directing workload, counseling, and disciplining; Coordinates and/or provides training, ensures cross training occurs, and other related staff development activities as needed.
• Understand and stay informed of the latest billing guidelines for Medicare, Medicaid, MCO's, commercial insurances, and self-pay.
• Reviews and updates account receivables database and takes appropriate action regarding any unbilled, denied, or underpaid claims.
• Recommend to Chief of Revenue Cycle which accounts should be written off and ensures write off process has been followed.
• Assists Chief Financial Officer with special billing reports as required.
• Identify denial trends and work with Chief of Revenue Cycle to address the root cause and make recommendations for front-end edits to minimize reimbursement delays.
• Assist team with validating appeal opportunities, creating appeal letters, generating, and submitting individual and/or batch appeals in a timely manner, tracking appeals and recoveries.
• Work closely with the Credentialing and Contracting teams to validate contracts and verify credentialed status.
• Attends all workshops/webinars/training offered in the area for Medicaid, Medicare, Managed Care Organizations, and/or commercial insurances as well as any webinars provided.
• Provides updated information to supervisor regarding any changes in fee schedule, procedure codes, contract information and/or limitations of benefits.
• Communication with Manager regarding Registration, Billing or Posting issues. Review these areas of inaccurate information and determine if there needs to be additional education/training with other departments.
• Assist in conducting internal audits for services of patient charges and corresponding documentation for ongoing improvement to the department.
• Collaborate with other departments to ensure maximization of encounter data is being reported monthly.
• Collaborates with the coding team to address coding-related denials.
• Serve as a super-user for multiple practice management systems and update software with rate changes, programs and/or services; Assists with process mapping and the development of workflows for best practices.
• Assist with end of the month financial closing requirements.
• Promote effective working relations, maximize team morale, work efficiently to meet goals and objectives of the department and organization.
• This includes the degree of cooperation, communication and coordination between this function and other employees.
• Reviews and approves return of monies refund request.
• Adhere to productivity standards using key performance indicators (KPIs) and established healthcare billing metrics.
• Demonstrates ability to tactfully handle difficult situations.
• Consistently shows ability to recognize and deal with priorities.
• Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires Associate's degree, supplemented by (2) years of experience in billing in a medical or behavioral health setting and one (1) year of supervisory experience; or possession of any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities.

Required Knowledge and Abilities

Knowledge of trauma-informed theories, principles, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

Unavoidable Hazards (Work Environment)

• Involves routine and frequent exposure to:
• Bright/dim light; Dusts and pollen.
• Other extreme hazards not listed above.

Special Certifications and Licenses

• Must possess and maintain a valid state Driver's License with an acceptable driving record.
• Must be able to pass a TB, criminal background and drug screen.

Americans with Disabilities Act (ADA) Compliance

Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.

Other Job Characteristics

• Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
• Credentialed, certified, and licensed professionals with adequate training in person-centered, family centered, trauma informed, culturally-competent and recovery-oriented care.

Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.