Medical Billing and Coding Manager

Position Summary:

The Medical Billing and Coding Manager is responsible for all aspects of the Medical Billing department, assuring all aspects of the department are running smoothly and that revenue numbers are being met while managing team members to meet individual goals.

Essential Duties/Responsibilities:

• Oversees the daily operations of the department, including workload and staffing; hiring, disciplining, and performance appraisals; training; and monitoring quality of work
• Ensure that needed documentation is current and aligns with billing policies
• Performs overall revenue management, including satisfying prompt filing requirements, maximizing billing revenue and collections, and resolution of denied/rejected claims
• Monitors monthly aging reports and conducts follow-up on unpaid claims and takes action to correct and re-bill for reimbursement
• Finds, researches, and resolves discrepancies through direct contact with payors and software vendors
• Supplies technical expertise to ensure correct practices are being performed, including coding, risk adjustment, billing for new services, and staying informed of regulatory changes, credentialing, changes in fee schedules, compliance, and best practices for medical coding and billing
• Performs regular audits of daily billing reports to find coding and billing errors. Work with Medical Billing Coordinators to address
• Monitors A/R aging and payment reports monthly to find trends and underpayments; investigates causes and takes proper steps toward resolution using professional judgment
• Supplies monthly updates of revenue cycle status, including reports, metrics, and presentations
• Works with proper management as needed to accomplish
• Provide training as required for on-site staff regarding Billing and other revenue cycle-related tasks and standard operating procedures (SOPs)
• Identifies the correct coding applications utilizing standardized coding conventions required for the patient charge encounters when reviewing provider generated codes, ensuring compliance with regulatory agencies, correct coding initiatives, and regulatory guidelines for clinical documentation.
• Identifies and reports correct code selection from physician documentation, including, but not limited to, chart notes, abstracting from medical records documentation, medical diagnostic and/or interventional reports, ensuring compliant coding selections are reported
• Proper risk adjustment coding taking place throughout the enterprise
• Oversee charge entry and reconcile charges against patient schedules
• Ensure that patients are charged for all procedures/services
• Identify trends and provide feedback to medical staff, supervisors, and administrative staff
• Partner with providers to inform them of new coding conventions or changes in current coding conventions, and provide feedback on individual coding practices
• May provide education and training

Additional Duties:

• Extensive knowledge of coding principles and guidelines, including CPT codes, EOBs, and denial reasons
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.
• Responsible for maintaining an Accounts Receivable report that summarizes the AR aging buckets and tracks denials that need to be disputed

Education and Experience Requirements:

• Minimum of 5 years medical insurance/healthcare Billing and collections experience in a medical practice or health system, with a deep understanding of Medical Billing rules and regulations
• Two years of supervisory or management experience required
• Experience with HCC risk adjustment models
• Experience working within a large outpatient physician practice or ACO preferred
• Extensive Knowledge of ICD-10, CPT, and/or HCPCS, HCC

Certifications/Licensure:

• Certified Risk Adjustment Coder (CRC) and/or Certified Professional Coder (CPC)

Required Skills/Competencies

• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services
• Ability to learn/stay abreast of relevant CMS and other payor billing policies/guidelines
• Excellent written and oral communication skills
• Excellent analytical skills
• Detail oriented, organized, and with a high degree of accuracy

Physical/Mental Requirements:

• Office/desk environment

Salary Range:

$65,000 - $80,000