| Department: Billing Department | FLSA: Exempt |
| Reports to: Director of Payer Relations | Approved Date: 12-2019 |
Summary:
Management position responsible to assist the Director with planning, directing and coordinating the overall functions of the medical billing and coding office to ensure a health revenue cycle is sustained while improving patient, physician, and other customer relations. The position requires strong managerial, leadership, and business office skills, including critical thinking and the ability to produce and present detailed billing activity reports. |
ESSENTIAL DUTIES AND RESPONSIBILITIES:- Maintain a proficient working knowledge of CMS-FQHC billing and collection regulations, HRSA Compliance Manual, KY Medicaid FQHC Regulation and CLIA regulations
- Ensure the activities of the Grace Health billing team (not limited to: Billing Work Queues, Follow up on Accounts Receivables, Manual Charge Entry, Refunds, Payment Posting, and Unapplied Credits) are performed in a manner consistent with the department’s processes and are completed in a timely manner
- Assist in the development, implementation, and sustainability of operating policy and procedures
- Oversee hiring and supervision of personnel including work allocation, training, problem resolution, cross training and performance evaluation
- Collaborate with Payers, ACO, Director of Quality and other Leaders to ensure processes are established to maximize Pay for Performance outcomes
- Audit billing and collection processes to monitor and improve billing and collections operations and provide specific feedback as indicated; examples may include audits of new providers, new services, payers, hospital location, PPS rates, timeliness of A/R f/u, etc.
- Facilitate compliance audits when concerns are identified as well as coordinate ongoing compliance audits such as Consolidated Claims, VFC, or Annual Wellness Visits; work with leadership to ensure process improvement is implemented as indicated and refunds are issued if an overpayment is identified
- Monitor compliance with timely submission of charges, lead efforts to address gaps, escalate gaps to CEO and CFO as indicated
- Collaborate with Leadership to submit required reporting, such as cost report information and the quarterly Medicare Credit Balance report. Monitor and report outcome metrics to billing staff and leadership
- Review and interpret operational data, including lag days, un-submitted charges, days in A/R, credit balance amounts
- Demonstrate proficiency and expertise with the functions within the Electronic Health Record, Epic; maximize the utilization of the system’s functions and reporting
- Communicate concerns related to the Revenue Cycle to appropriate leadership and help develop process improvement as needed always ensuring sustainability
- Work on special assigned projects
- Participate in professional development activities and maintain professional certification as applicable
- Ensure thorough communication and exceptional customer service with internal and external customers. Timely F/U with all patients inquires
- Other duties may be assigned
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OTHER ESSENTIAL DUTIES and RESPONSIBILITIES:- Grace Health recognizes that managing patient care is a team effort that involves clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
- Team members must demonstrate excellent team communication and coordination to provide quality patient care.
- Care coordination includes communicating with community organizations, health plans, facilities, and specialists.
- Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by this practice.
- Team members must demonstrate skill and knowledge related to effective communication with vulnerable patient populations.
- Team members must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high quality care.
- All team members will be involved in the process of improving quality incomes.
- Team members will participate in the review and evaluation processes of practice performance and help to identify opportunities for improvement.
- Team members will participate in Grace Health's advocacy program.
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GENERAL DUTIES:- Follows policies and procedures of the office, including administrative, clinical, quality assurance, and personnel
- Maintain good attendance (daily, meetings, and other assignment tasks)
- Maintain timely documentation of all work assignments
- Maintain patient confidentiality
- Routinely keep supervisor informed about attendance and job assignments
- Flexible in being able to multitask
- Work effectively and at an efficient pace
- Work cooperatively with providers, administration, and peers
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QUALIFICATION REQUIREMENTS:
To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SKILLS:- Excellent organizational, analytical and decision-making skills
- Effective leadership and managerial skills
- Exceptional customer service skills; must be able to establish and maintain effective working relationships with employees and other Grace Health leaders
- Effective written and oral communication skills
- Highly organized work habits with ability to prioritize
- Exceptional computer skills, including knowledge of the EMR/PM and Excel
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EDUCATION and/or EXPERIENCE: - Bachelor’s Degree in related field
- Minimum of three (3) years of experience in a health care setting
- Management experience preferred
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PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; sit; and use hands to finger, handle, or feel objects, tools, or controls. The employee is occasionally required to reach with hands and arms; stoop, kneel, crouch, or crawl; and taste or smell.
The employee must occasionally lift and /or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. |
WORK ENVIRONMENT:
Grace Health is a faith-based, federally qualified community health center (FQHC). We provide primary health services to underserved, underinsured, and uninsured individuals in the southeastern Kentucky region. Our mission is “to show the love and share the truth of Jesus Christ to southeastern Kentucky, thorough access to compassionate, high quality, primary health care for the whole person” regardless of ability to pay.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally exposed to wet and/or humid conditions, fumes or airborne particles, and toxic or caustic chemicals.
The noise level in the work environment is usually moderate. |
