Job summary:

The Billing Manager will provide reporting services and assistance to the Director of Revenue Cycle. This position is responsible for gathering and submitting appropriate documentation for the appeal process. Oversees billing operations by developing metrics and setting goals for the department. Position requires impeccable organizational and analytical skills and strong attention to detail and follow-up.

Job responsibilities and Duties:

• Report quarterly collection volume and trend reporting to the Director of Revenue Cycle. 

• Assist Director of Revenue Cycle in various projects to increase collection efficiency.

• Identify, monitor, and report critical KPI data to the Director of Revenue Cycle. 

• Identify payment trends and denial rates, and work to resolve to improve collection efficiency and timely claim closure.

• Electronic and manual claims posting from various remittance websites such as TriZetto, Optum, Payspan and PNC.

• Claim follow-up and accurate tracking across various spreadsheets.

• Perform prior authorization requests as needed.

• Interact with clients and patients to procure necessary documents and filing appeals as needed.

• Update & enter in BIS all information that has to do with billing, such as new codes, prices changes/increases, etc. 

• Increase revenue though the proper billing channels. 

• Works with management assure billing is being completed properly and timely

• Submit medical records and appeals as necessary to ensure completion of claims processing.

Job requirements and qualifications:

To perform this job successfully, an individual must be able 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.

• Strong communication skills: verbal and written.

• Mastery of medical coding according to NCCI standards.

• Experience posting payments, both manual and electronic.

• Strong background in claims appeals and grievances.

• Experience with prior and retroactive authorizations.

• Experienced in pre- and post-claim follow-up.

• Familiarity with a laboratory setting and basic knowledge of science terms a plus

Education/Experience:

• BA/BS from an accredited program. 

• Experience: 5 Years as a billing manager (Medical Billing and or coding experience) 

• Experience working in the medical field.

Math Ability:

• Basic retail-level mathematical skills.

Reasoning Ability:

• Define problems, collect data, establish facts, and draw valid conclusions.

Computer Skills:

• To perform this job successfully, an individual should be proficient in Microsoft Excel, Word and Outlook.

Supervisory Responsibilities:

• Interviews prospective employees and chooses the best applicant based on skills, knowledge, and abilities required for the job.

• Trains and oversees employees involved in billing functions.

• Directs assigned tasks and provides assistance as needed.

• Assists with performance evaluations.

Work Environment:

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.

The noise level in the work environment is usually moderate.

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 sit for extended periods of time and occasionally required to stand.

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.