Dept: Medical BillingReports to: COOExempt/Nonexempt: ExemptPosition Summary:Responsible for efficiently and effectively directing and coordinating the overall functions of the Medical Billing department to ensure maximization of cash flow while maintaining and improving relationships with PPCW staff, patients and payers. A member of Patient Services Management Team, particular attention must be paid to fostering a closely coordinated relationship between the Medical Billing team and Patient Services to ensure accurate and timely coding. This includes planning, budgeting and managing the financial, human and physical resources of the department. Responsible for ensuring compliance with existing policies, procedures and contractual commitments as well as for recommending, implementing and monitoring compliance with internal policies and procedures. Tracks the progress of the department in achieving goals and communicates this to the C)O. Responsible for meeting internal requests for billing data and for suggesting ways to increase revenue.Key Responsibilities:- Plans and directs registration, patient insurance, coding, billing, collections and data processing to ensure accurate patient billing and efficient account collection.- Manages the Billing Office within the established budget, including annual planning, and develops monthly status reports.- Supervises, trains, orients and evaluates performance over assigned personnel. Recommends merit increase, promotions, and performs disciplinary actions. Mentors staff and provide instruction and training/improvement opportunities.- Oversees Medical Billing Clerks and Coordinator in preparing, printing, and mailing weekly HCFAs (CMS reimbursement forms) and patient statements, and in posting all payments.- Reviews current status of patient accounts to identify and resolve billing and processing problems in a timely manner.- Maintain/implement changes to the collection of delinquent accounts ensuring third party payers are contacted. - Establishes and recommends credit and collection policies. Make recommendations for improvement.- Solves difficult payment and associated business office problems. Audits problem accounts.- In coordination with the COO, negotiates payer contracts to maximize reimbursement to PPCW.- Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings.- Develops and implements new procedures to improve the quality and quantity of work processed. Ensures polices are communicated and administered consistently. - Monitors daily operating activity of department and makes necessary adjustments in work assignment.- Initiates and answers pertinent correspondence. Prepares and writes reports. Make verbal and written presentations. Maintains required records and files.- Maintains knowledge of and complies with established policies and procedures including government, insurance and third party payer regulations.- Attends administrative meetings and participates in committees as requested. Conducts special projects and studies as directed.- Participates in professional development activities and maintains professional affiliations.- Represents PPCW at public and professional meetings and conferences as requested. Facilitates communications and ensures proper flow of information. - Creates various billing reports and data, including charge and collection statistics by site and provider, aging reports and other(s).- Interfaces effectively with other customers, such as clinics and insurance companies.- Recommend new policies or changes in existing policies to the CFO, CEO, COO and Senior Management.- Daily: review charges on End of Day report for consistency and accuracy, resolving with clinics as needed; ensure daily insurance/payments deposit ties to End of Day report for Insurance Billing.- Weekly: review and process patient and insurance refunds. Audit random batches to ensure correct coding. - Monthly: Process and balance month end reports, complete monthly purge of patient accounts, review applied payments.- Quarterly: conduct chart audits to monitor and improve compliance (data entry, billing, charting, etc.).- End of Year: Perform End-of-Year close out of billing system in coordination with the CFO and Administration. Perform Year-End purge. - Monitor payments; assess rejections by insurance companies; ensure re-billings as necessary; coordinate collections from private pays with clinics and collection agency as necessary, recommending write-offs to COO for approval; resolve patient account complaints and process refunds.- Provide support to clinics on billing procedures (maximizing coding and ensuring Regional Managers, PSS and Clinicians are trained/performing tasks correctly). Ensure correct setup of all NextGen Modules: Client Billing, Pharmacy, Inventory, Labs, and Insurance.- Regularly review Encounter Form design for maximum accuracy in coding and efficiency in billings.- Monitor relationships with founders for current setups in MM.- Interface with VP of Patient Services and/or Director of Medical Services for changes to any medical procedures/protocols, medications/supplies, or lab tests.- Interface with appropriate vendors for resolving problems, changes, and improvements.- Promotes excellent internal and external customer service.- Performs other related duties as assigned.- Must be able to sit, bend neck forward and/ or sideways and twist neck, and perform simple and power hand grasping at a computer workstation for up to 8 hours per day.Competencies & Essential Skills:Leadership Sets a positive example for others, takes initiative on key business issuesStrategic Able to develop strategic billing strategies in support of the organization and establish plans to executeBusiness Knowledge Understands products and services; knowledgeable of operations and fiscal responsibilitiesBilling Expertise Knowledgeable of complex billing systems.Management Plans resources, organizes and adjusts to achieve goals through collective effortsOrganization Able to manage multiple issues and projects while responding to unplanned issues.Team player Demonstrates behavior that brings people together to solve problems and achieve resultsConfidential Able to manage information in a way that honors all parties; acts with integrity and professionalismCommunication Communicates clearly and concisely in speaking and writing; facilitates communication of others as appropriate; delivers effective presentations. Requires proficient English speaking and writing skills.Problem Solving/Objectivity Able to see all aspects of a situation and presents non-biased solutions; drives for closureCustomer Service Strong internal and external customer services skills. Computer and Office skills Must be proficient with Microsoft Office including excel. Knowledge of EPM and EMR systems.Travel Required to travel to outlying areasWork hours May be required to work hours beyond typical office hours.Education/Experience Required:- BA/BS Degree, CPC Certified, preferred.- 5-7 years experience managing a complex billing department- Strong leadership and organizational skills- Experience with electronic practice management systems and electronic medical records- A strong commitment to the goals and mission of PPCW