This person is responsible for directing all billing
operations for the practice. These tasks include, but are not limited to,
resolution of billing inquiries and patient education on the billing process,
appealing all denied claims, updating fee schedule annually and processing
refunds. Position oversees 1 billing assistant and works closely with all other
department leads on a regular basis to ensure cohesive processes and protocols
for the practice.
for management of billing personnel including but not limited to recruitment,
training, counseling, PTO approvals, annual reviews and termination of staff.
Directs the billing
operations including but not limited to, claim submissions, adjustments and
write-offs, appeals, collections from patients, insurance companies and
institutions, bad debt and refunds.
that all patient inquiries and complaints regarding billing are handled in a
timely manner including the logistics of refunding a patient account.
Analyzes data to
identify trends related to denials and rejections; develops and executes plans
to avoid, reduce, and resolve denials and rejections.
understanding of payor contract details and continually monitors
and confirms that payors are adhering to the terms including, but not limited
to, negotiated fee schedules.
payors/plans that should be considered by the practice on an ongoing basis.
Maintains updated fee
schedule including the addition of internal “CPT codes” as needed.
closely with Front Desk Lead to train new staff on billing and internal
protocols; Works in conjunction with Front Desk Lead to continually improve
patient collection processes and “chart prep processes” including the gathering
of correct demographic/insurance information and authorizations.
current credentialing for all doctors.
1. Thoroughly reviews, analyzes and negotiates existing payor contracts?
2. Sets annual fee
3. Initiates, plans and collaborates with clinic staff to perform audits.
4. Initiates, plans,
and executes annual billing and coding staff training in conjunction with
“Billing Dashboard Report” and “Productivity Report by Facility” for the
previous month by the 3rd of the month (or next business day) and
emails to Dr. Collins, Administrator, and Accounting Manager along with an
analysis of the following KPI’s:
- Net Collections Ratio
- Days Outstanding
- A/R Report broken down by payor
Analysis will include proposing solutions to any challenges being faced.
- Maintains a monthly account of
receivables over 30, 60 and 90 days, seeing that over-due accounts are referred
to outside collection agency as needed and worked every 28 days.
- Works closely with accounting
manager to coordinate collection analysis of accounts receivables and
collections data to seek out trends, patterns and identify ways to improve
cash collections as well as reducing aging.
- Plans and executes monthly
billing/coding training session with 1) front desk staff and 2) scribes
based on researched trends and patterns.
1. Research patient
refund requests and ensures communication has occurred with patient regarding
refund type such as credit card versus check. If check is requested, discusses
with accounting manager prior to refund given.
1. Ensures that claims are submitted daily by 10am for the previous business
2. Ensures that all insurance payments received by the bank account are posted daily.
3. Ensures that patient statements are reviewed over closely before being sent