JOB SUMMARY

Under the general direction of the Director of Business Services and the Business Services Manager, the Physician Practice Billing Coordinator will assist in planning organizing, and direct all physician billing specialists to process daily functions. The department includes Physician Practice billing specialists to abide by administrative functions in accordance with The Joint Commission, federal, state, and local guidelines, organization and departmental policies and procedures. The position communicates with medical staff, other departments, and outside agencies while maintaining confidentiality. The position requires self-motivation, creativity, and capabilities to function in a semi-autonomous role within a fast-paced and dynamic environment. The position is responsible for the supervision of multiple professional and clerical personnel. Position is delegated the authority, responsibility, and accountability to carry out assigned duties.

STANDARDS OF PERFORMANCE

1. Manage physician billing specialist workload to assure accuracy and timeliness of claims processing and patient collections and maintain proper cash flow.

2. Assist with Accounts Receivable balance to the standard of less than 60 days. Updating of compliance goals to reduce AR days will be ongoing.

3. Assist with activities in the physicians offices to ensure the accuracy of registration information, collections of deductibles/coinsurance, and compliance with registration procedures.

4. Monitor process to ensure UB-04 and 1500 data accuracy before billing to payors.

5. Assure that cash posting adheres to accuracy with discounts, contractual allowances, and payment posting calculations.

6. Provide proper review of Medicare/Medicaid billing procedures and proper correction of denials and adjustments.

7. Maintain knowledge of electronic billing processes.

8. Monitor secondary insurance claims filing within five days of receipt of primary payment.

9. Provide oversight into physician charges billed every month.

10. Review and monitor the process for credit processing monthly.

11. Provide oversight into the billing process for long-term care claims and private pay accounts.

12. Reviews Business Services policies and procedures and job descriptions, recommends changes, and keeps manuals updated.

13. Evaluates the qualification and competency of all departmental personnel in accordance with time frames established by the organization.

14. Coordinates continuing education for staff in accordance with needs and participates in continuing education for self.

15. Makes recommendations to the Director Business Service to assist in developing new programs and research for special projects to improve performance.

16. Prepares departmental annual operating budget and capital equipment budget and operates department expenditures within the approved budget.

17. Responsible for maintaining organizational facilities in accordance with the Joint Commission, federal and state, organizational and departmental policies, and procedures.

18. Responsible for reporting payer issues such as take backs, denial trends, and patient or team members issues.

19. Adheres to other duties as assigned

JOB QUALIFICATIONS: 

Minimum Level of Education: Education level high school graduate and combination of work experience/education for five years.

Formal Training: Leadership skills with experience in planning, organizing, implementing, facilitating, interviewing, counseling, and verbal and written communication.

Licensure, Certification, Registration: Certified Patient Accounts Representative (CPAR) preferred.

Work Experience: Two years of supervisory experience in healthcare billing. Intermediate computer skills with word processing and spreadsheet capabilities are required.

Skills: Must demonstrate through work experience a knowledge of effective communication with the public, including accepting both praise and criticism and the ability to turn negative communication into a positive outcome for the public or customer. Must be able to meet and deal with people from all walks of life favorably and communicate positively and objectively with all people. Must be able to demonstrate ability to develop a plan of work and execute the plan through completion in a timely and effective manner. Adhere to other duties as assigned.