Provides leadership, establishes goals, and oversees the execution of departmental goals. This position is accountable for overseeing the critical activities of the EDI billing processes for Institutional, Managed Care, Medicare and Medicaid areas. Ensures all personnel are fully trained in the established procedures for the department.
The ideal resource will be the liason to IT with regards to EDI implementation; experience with 5010 implementations is a large plus, experience with large volume, including billing and working with payors nationally across multiple states.
Responsible for all healthcare claim billing functions including production of claims, review for edits and delivery of same
Responsible for electronic transmission of claims, remittances and other HIPAA compliant transactions
Responsible for set up and maintenances of billing rules/system
Responsible for resolution of delays or decreased quality of claims
Responsible for determining cause and resolving technical claim denials
Ensure claims meet payer requirements, including edi applications and enrollments
Works closely with IT team to resolve issues
Supervises a team of 15-20 professionals
Develops, implements and maintains systems, procedures, policies and internal controls related to Billing, ED
Provides strategic direction, critical analysis and senior technical leadership to IT and other departments to ensure system capability for new contracts and program offerings, in addition to sufficient contact and education to exchange electronic transactions.
Provide review, oversight and management of contracting process, terms and conditions, models and reports.
Researches, implements and tests new lines of electronic billing and posting, and conducts other projects requiring vendor contacts.
Provides expertise on technical EDI issues.
Reviews and evaluates all commercial contract opportunities, including both reimbursement terms and language and offers recommendations to the director and others within Company as appropriate.
Provides analysis and detailed reports on issues affecting Billing, and EDI
Monitors all aspects of the revenue cycle to assure proper controls are established, information is collected accurately and all accounts are handled promptly and in full compliance with all Federal, State and local policies.
Initiates actions to improve workflow, simplify operational procedures, implement cost reductions, and improve performance standards.
Works closely with others to coordinate activities to facilitate new programs that involve system enhancements.
Manages and leads project teams that are multi-departmental to facilitate projects.
Evaluates the resources required to test and implement new contract or program offerings.
Directs team leads and supervisors in employee relations activities including timely performance evaluations and training and development.
Bachelors Degree in Accounting, Business, or related field.
At least 6 years experience with EDI, Billing, and collections including supervisory experience of 3 yrs plus
Experience with EDI Healthcare with Institutional and Third Party Payers.
Knowledge of Managed Care, A/R and Collection regulations such as the Fair Debt Collections Practice Act
Knowledge of billing/coding terminology (ICD-9, CPT, Revenue Codes)
Demonstrated Credit, Billing and Accounts Receivable/Collections experience in the medical field,
Knowledge of Medicare/Medicaid, Managed Care Regulations, HIPPA EDI and business process analysis.
Knowledge of 1500 Forms, EOB (Explanation of Benefits) and denial codes
Experience with managed care appeals and denials management
Ability to management multiple projects simultaneously.
Ability to organize, manage and motivate professionals.
Demonstrated communication and presentation skills.
Ability to work in a team environment, as well as independently.