Director of Billing - HealthCare

About the Role

The Director of Billing manages the billing and collections for California Medicaid, ensuring smooth operation, efficiency, and adherence to state deadlines. This role oversees claim production, processing rejections, handling denials, and reconciling submissions to secure revenue from payers and funding sources.

Responsibilities

• Generate service charges into revenue for BayMark Health Services.
• Review and monitor processes for system processing and third-party payers, reporting problems or adverse trends to the VP.
• Ensure billing tasks are completed timely and effectively.
• Act as an authority for escalated billing concerns and workflow issues from clinical and interdepartmental personnel.
• Coordinate billing efforts and payer sequencing.
• Create training materials for RCM and treatment center staff (e.g., payer selection, modifiers, codes, timeframes, payer plan changes).
• Train, counsel, monitor, and provide feedback to employees, including action plans for improvement.
• Assist in training new employees and provide continuous education on departmental policies and insurance regulations.
• Oversee payroll for assigned subordinates.
• Review, coordinate, and create billing process workflows for existing and new business.
• Lead conference calls with sub-divisions across the U.S. to discuss operational needs and new payers.
• Participate in acquisition, De Novo calls, and due diligence activities.
• Prepare for and participate in monthly operational status, developmental, and bi-weekly management calls.
• Assist in hiring activities, evaluate employee performance, and handle disciplinary actions/terminations when necessary.
• Maintain HITECH HIPAA privacy compliance for staff and patient information.
• Handle stressful situations and interact professionally with others.
• Comply with company policies, procedures, compliance guidelines, and Code of Conduct.
• Maintain regular attendance and interact positively with all levels of the organization.
• Complete special projects for all BayMark regions and billing modalities.
• Travel by plane or car as required.

Requirements

• At least 18 years of age.
• 5+ years of physician office, hospital billing, or cash management experience.
• Strong working knowledge of third-party billing and reimbursement, with an emphasis on Medicaid.
• Experience in medical terminology, OTP coding, and the authorization process.
• Working knowledge of MCO authorization requirements.
• Excellent verbal and written communication skills.
• Data entry experience and ability to fill in for other employees as needed.
• Compliance with HIPAA policies.
• Proficient in Microsoft Word and Excel.
• Ability to multi-task, handle large volumes of detail work accurately, and meet deadlines.
• Satisfactory references from employers and/or professional peers.
• Satisfactory criminal background check and drug screen.

Benefits

• Competitive salary.
• Comprehensive benefits package including medical, dental, vision, and 401(K).
• Generous paid time off accrual.
• Excellent growth and development opportunities.
• Satisfying and rewarding work contributing to overcoming the opioid epidemic.