BILLING SUPERVISOR I

Essential Job Functions

• Demonstrates a working understanding of Medicare, Medi-Cal, FQHC (Federally Qualified Health Center), state, local programs, and private insurance regulations as they apply to payment posting, follow-up, and AR.
• Directly supervises payment posting, follow-up, and AR staff: coordinates daily work activities; organizes, prioritizes, and assigns work; monitors status of work; inspects completed work; troubleshoots problem situations; and assists staff with interpretation of policies/procedures.
• Oversees timely and accurate posting of payments, adjustments, ERA/EFT remittances, and ensures unposted and unapplied amounts are resolved promptly.
• Manages self-pay receivable accounts: monitors payments; assesses rejections by insurance companies; ensures re-billings as necessary; audits and writes off small-balance accounts receivable for self-pay accounts; sends patient accounts to the collection agency and updates accounts on the website.
• Directs accounts receivable follow-up: researches and resolves outstanding claims on aging reports for medical, mental health, optometry, and ancillary services; responds to payer requests and remittance advices through telephone correspondence, letter responses, appeals, and submission of medical records and additional information promptly and professionally.
• Works with HIS departments to complete billing inquiries from attorneys or other third parties.
• Participates in and supports month-end closing to confirm payments are accurately posted on time.
• Reviews unapplied amount reports and accounts receivable credit balance reports and drives their resolution.
• Answers patient inquiries and billing complaints by making adjustments as necessary, exercising all options to obtain claim payments, referring patient inquiries to appropriate staff, and ensuring proper follow-up.
• Handles patient concerns that are unable to be resolved by other staff members.
• Acts as a liaison between physicians, insurance companies, and third parties by verifying EOBs, ensuring payments and claims, and reviewing reimbursements on the back end.
• Captures charge, coding, and enrollment issues affecting posting or follow-up and routes and resolves them at the source.
• Uses the Epic Professional Billing environment for posting and follow-up workflows and reports application issues to the Epic Analyst (who owns system configuration).
• Assists the Revenue Cycle Manager in determining probationary and annual evaluations for Billing staff and in the recruiting process for Billing staff.
• Trains new employees on payment posting, follow-up, and AR software and workflows, as appropriate.
• Generates Epic AR, posting, and collection reports as requested by the Revenue Cycle Manager, CFO, or Administration.

Qualifications

• Completion of a four-year degree from an accredited university.
• Four or more years of experience in a medical billing setting, FQHC experience is preferred.
• Two or more years of experience leading or training employees.
• Epic Resolute Professional Billing (PB) certification is preferred but not required.
• Ability to handle responsibility and a demanding work pace.
• Must be accountable to handle money and balance finances.
• Able to provide excellent customer service and assist in the resolution of disputes.
• Understanding of the varying rules and regulations which apply to the healthcare industry, including HIPAA, the False Claims Act, and OSHA compliance.
• Familiar with and adheres to CPT, ICD-10 codes, modifiers, and HCPCS Level II coding guidelines as they relate to payment and denial resolution.
• Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic.
• Language: Must be able to fluently speak, read and write English. Fluent in Chinese (Cantonese and/or Mandarin) is required. Fluent in other languages is an asset.