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Billing Manager Job in Raleigh, North Carolina

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Job Title: Billing Manager

Employer:Avance Health Systems Inc
Required Certifications:CPC
Preferred Certifications:CPC
Location:10900 World Trade Blvd Ste 207 Raleigh 27617, NC, US
Date Posted:1/4/2021

Job Purpose: Lead Certified Professional Coders (CPCs) to generate the best possible financial outcome for the practices at the lowest possible compliance risk through primary care advocacy, research, collaboration, structured communication, and standardized processes.

Essential Duties and Responsibilities




       Ensure compliance to:

o    Coding standards as defined by the AMA through CPT, ICD, and HCPCS

o    Government and Commercial Payer Contracts

o    Accountable Care Organization (ACO) agreements

o    CPT Category II quality reporting

       Hold and attend regular meetings with coders, billing staff, providers, managers, and other stakeholders to share information and communicate on company issues, as needed

       Interview, hire, and provide orientation to coding staff

       Reporting including, but not limited to:

o    Monthly status reports

o    Insurance fee schedules

o    Charge lag including claims awaiting provider completion and claims awaiting coding.

       Support Avance Care’s strategic execution of ACO agreements, as they relate HCC/RAF, CPT Category II coding, and other coding deliverables.

       Compliance planning as it relates to government and private contracts, rules, and regulations, including execution of compliance policy and procedure at the coding level.


Claims Management:


       Execute all facets of the coding aspect of revenue cycle management.

       Ensure scalable but nimble coding structure that supports the organization’s growth plan

       Supervise and train coding staff, both local and outsourced.

       Manage department workload and growth, including assignment of work and staffing plans

       Regularly review coding and documentation for accuracy and compliance.

       Supervise all coding employees in order to:

o    Ensure adherence to Avance Care Policies and Procedures

o    Encourage employee behavior that represents the company in the best light

o    Ensure standardized processes are executed efficiently

       Oversee all claims production, including creation, submission, secondary claims, and charge lag.


Personnel Management

       Resolve conflicts within the department

       Resolve issues outside the billing department, such as providers, operators, or regulators

       Communicate effectively and politely with all staff members to minimize and eliminate employee dissatisfaction and conflicts

       Address employee complaints in a timely manner

       Interview, train, counsel, coach, discipline, and terminate employees, as necessary

       Manage employee scheduling, vacation requests, and continuous shift coverage

       Conduct staff meetings to share information and communicate on company issues

       Train new and existing providers, with assistance from coding team

       Review, revise (as necessary), and maintain Operating Procedures and Training Manuals

       Conduct bi-annual employee performance evaluations

       Notify the Vice President of RCM, Human Resources, and other managers of all non-routine matters relating to the operations and affairs of the areas for which the position is responsible, including but not limited to significant concern, current problems, and potential problems


Expectation of Employee

       Understand, follow, and enforce Avance Care’s Policy and Procedures, as documented in the Policy and Procedure Manual

       Always maintain company, employee, and patient confidentiality

       Maintain an effective relationship with physicians, employees, co-workers, and management

       Work at least 40 hours each week

       Work as a team player

       Use strong computer skills and general math skills

       Use strong attention to detail

       Uses superior judgment, negotiation, and decision-making skills

       Capability to guide the organization and execute various changes

       Perform administrative and coding duties as workload necessitates

       Use tact in all personal and patient interactions

       Demonstrate flexible and efficient time management and ability to prioritize workload

       Consistently report to work on time for scheduled shift, prepared to perform duties of position

       Accomplish all tasks as assigned or become necessary


Experience, Education and Licensure:

       Batchelor’s Degree required (MHA or MBA preferred)

       Minimum 5-7 years office-based coding management experience

       CPC Certification required (additional certifications such as CPME, CRC, CDEO preferred)

       Multispecialty, hospital, ambulatory, and/or surgical coding experience preferred

       Knowledge of CPT, HCPCS, and ICD-10 coding

Knowledge, Skills, and Abilities:

       Ability to read and interpret documents

       Ability to write reports, business correspondence, and procedure manuals

       Ability to effectively present information in person and virtually

       Ability to interact and communicate with a variety of people

       Ability to anticipate and react calmly to emergency situations

       Ability to work with mathematical concepts such as probability and statistical inference; ability to apply concepts such as fractions, percentages, ratios, and proportions to practical solutions

       Ability to define problems, collect data, establish facts, and draw valid conclusions

       Ability to make independent decisions and delegate responsibility and duties

       Ability to follow direction

       Proficient computer skills, including knowledge of EHR, Microsoft Office Suite, e-mail systems, and web-based programs

       Ability to handle multiple tasks simultaneously

       Excellent supervisory, managerial skills

       Strong leadership qualities

       Knowledge and understanding of how for-profit medical practices run

       Working knowledge of accounting, including ledger, balance sheet, payroll, taxation, etc.


Send resumes to 

Nicole Nishimoto

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