Medical Billing & Coding Manager

J  o  b    D  e  s  c  r  i  p  t  i  o  n

Job Information

Title:

Medical Billing & Coding Manager

Market Range:

MR19

Approved Date:

4/26/2021 4:26:02 PM

FLSA:

Exempt

EEO Code:

PROFESSIONALS

Career Level:

M1

Career Level Description:

Management Level 1

Job Code:

100533

Job Family:

Fiscal and Business Management

Sub Family:

Accounting

Primary Purpose

Manages the Billing and Coding Unit and general medical billing for insurance companies (payors) and patients focused primarily on maximizing collections for Public Health Clinics. Manages the Credentialing Coordinator to ensure provider enrollments and credentialing is submitted and maintained to bill all payors. 

•

Manages Billing and Coding supervisors and Provider Credentialing Coordinator responsible for billing management, collections, researching customer issues, reconciliation, business process improvements, and ensuring compliance with billing and coding procedures.

1

25%

•

Works directly and independently with counterparts at insurance companies and Medicaid to understand proper and accurate billing processes, billing codes, authorization codes and legal compliance.

2

20%

•

Closes payment batches daily, and oversees reconciling individual carrier payments and Eligibility Of Benefits statements.

3

15%

•

Executes active problem solving in resolution of concerns and/or errors that arise related to patient reports and billing Current Procedural Terminology codes, including investigating root causes, and proposing solutions to fix current problems as well as reduce opportunities for future errors and providing support for audits.

4

15%

•

Collaborates with Information Technology software developers, Clinic Managers, and Lab manager in the development of new applications, and to modify existing applications for the purpose of process improvement and reporting accuracy.

5

15%

•

Provides staff support through effective supervision, coaching and performance management.    

6

10%

Position(s) may perform other duties in addition to the above as assigned by management.

•

Participate in monthly telephone conference meetings with Director of Clinical Operations, IT Staff and Records Supervisor to allow best practice and other techniques to be shared.

*IMPORTANT* In the event of an emergency, as determined by the County Manager or designee, participation in preparedness and response operations should be expected. Employee may be required to fill a temporary assignment in a role different from standard duties, work hours and/or work location in preparation for, during and after the emergency. Employee may also be required to participate in relevant exercises and regular preparedness training.

Career Level Dimensions

Career Level:

M1

Career Level Description:

Management Level 1

•

Plans and establishes operational objectives for a team of support employees within a Work Group.

•

Typically does not have budget accountability but may manage day-to-day elements of the budget (e.g., overtime for staff).

•

Responsible for making basic improvements to processes, systems or standards to enhance performance of the Work Group or team.

•

Communicates within and outside the Work Group.

•

Explains policies, practices, and procedures and may justify and gain cooperation of other parties.

•

Supervises support roles. Leads, directs and reviews the work of team members in order to accomplish operational plans and results.

•

Has hiring, firing, promotion, performance and rewards decisions for direct reports.

•

Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution. Typically requires advanced knowledge of job area typically obtained through advanced experience.

Qualifications

•

Bachelor's degree

•

Four years of job-related experience including one year supervisor experience

•

Certified Coder - AHIMA or AAPC

•

Equivalent education and experience are accepted

•

3 Years

Billing experience within a healthcare environment.

And

•

3 Years

Experience in claims follow-up/accounts receivable/revenue cycle.

•

Excellent analytical abilities with an understanding of billing, accounts receivable and collections principles 

•

Supervision skills with ability to provide guidance and professional support to staff, offer regular feedback, hold staff accountable, and serve as a mentor.

•

Strong interpersonal skills. Ability to communicate clearly and effectively with senior management and other departments and staff. 

•

Strong organizational and attention to details skills.

•

Knowledge of third-party physician specialty billing, contractual and compliance regulations, along with a demonstrated understanding of automated processes and claims submission.

•

Detailed knowledge and understanding how data flows within applications, how configuration or changes within the system can affect processes, and how to reconcile data and get information needed by business owners to make decisions.

•

Ability to understand, interpret, and apply the laws and regulations pertaining to billing and coding.

•

Ability to demonstrate initiative and independent judgment in analyzing data, dealing effectively with ambiguity, recognizing trends, identifying approaches and offering a variety of options and solutions to solve problems.

•

Ability to work independently in carrying out oral and written instructions.

•

Exceptional critical thinking and analytical ability with demonstrated troubleshooting and problem-solving skills.

An individual must be able to perform each essential duty satisfactorily to perform this job successfully. The requirements listed above 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.

Competencies

Analysis

Examines data to grasp issues, draw conclusions, and solve problems.

Attention to Detail

Thoroughness in accomplishing a task through concern for all the areas involved, no matter how small. Monitors and checks work or information and plans and organizes time and resources efficiently.

Consulting

Applies knowledge of policies and procedures in the area of work to advise others across the organization on critical issues.

Problem Solving

Builds a logical approach to address problems or opportunities or manage the situation at hand by drawing on one's knowledge and experience base, and calling on other references and resources as necessary.

Coaching & Mentoring

Works to improve and reinforce performance of others. Facilitates their skill development by providing clear, behaviorally specific performance feedback, and making or eliciting specific suggestions for improvement in a manner that builds confidence and maintains self-esteem.

Team Leadership

Willingly cooperates and works collaboratively toward solutions that generally benefit all involved parties; works cooperatively with others to accomplish organizational objectives. Manages staff in ways that improve their ability to succeed on the job.

Integrity

Act with honesty, transparency and respect in our interactions with co-workers and those we serve. Adhere, without exception, to laws, policies, procedures and professional standards.

Accountability

Establish high-quality standards for work. Add value. Measure results and hold self and others accountable for making progress toward desired outcomes. Take a logical and data-driven approach to decision-making.

Diversity

Believe that different backgrounds and experiences strengthen the organization and produce better results. Value inclusion across race, gender, age, religion, identity and experience, and strive to reflect in our workforce the diversity of our community.

Collaboration

Foster a work culture in which different ideas and opinions are encouraged and expected. Listen carefully and speak thoughtfully. Work together toward shared goals with mutual respect and cooperation.

Continuous Improvement

Continuously improve work processes and products. Provide a safe environment to be innovative and creative and try new things. When things don't go as planned, use it as an opportunity to learn, regroup and begin again. Provide time and resources for individuals to grow and develop both personally and professionally.

Wellness

Take proactive steps to be physically fit and healthy, emotionally strong, financially secure and socially fulfilled, while inspiring and empowering others to do the same.

Service Orientation

Commit to making a difference within the community. Actively engage in and enjoy our work. Deliver services that exceed expectations, with courtesy, politeness and sensitivity to the experiences, concerns and feelings of all co-workers and customers.

ADA Checklist

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

Standard ADA Selection:

Office Environment

Standing

X

Walking

X

Sitting

X

Lifting/Carrying 0-10 pounds

X

Lifting/Carrying 10-20 pounds

X

Lifting/Carrying 20-50 pounds

X

Lifting/Carrying 50-100 pounds

X

Pushing

X

Pulling

X

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Handling

X

Grasping

X

Fingering

X

Feeling

X

Talking

X

Hearing

X

Visual Perception

X

Repetitive Motions

X

Eye/Hand/Foot Coordination

X

Memorization/Concentration

X

Learning/Knowledge Retention

X

Preparing/Analyzing Numerical Figures

X

Use of Interfaced Commmunication Devices (Phone, Computer, Radio etc.)

X

Analyzing/Examining/Testing Data

X

Emotional/Behavioral Self-Regulation

X

Interacting with Others

X

Comprehension

X

Organization

X

Decision Making

X

Comprehension

Understand complex problems and collaborate to explore alternative solutions

Organization

Organize and prioritize the work schedules of others to manage multiple tasks and/or projects

Decision Making

Make decisions that have an impact on the immediate work unit's operations and/or services

Communication

Communicate in-depth information for the purpose of interpreting and/or negotiating

Extreme cold

X

Extreme heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Computers/Monitors

X