This role will oversee the billing for the Spine division of this multidivisional business – must have experience with OUT OF NETWORK Billing
Strong supervisory, attention to detail and go getter attitude.
The Medical Practice Billing Manager is responsible for overseeing and managing the “out of network” billing operations of multiple medical practices. This role ensures the accurate and efficient processing of medical claims, revenue cycle management, and compliance with relevant regulations. The Billing Manager will lead a team of billing specialists and is required to have a strong understanding of medical billing, coding, and reimbursement processes. The ideal candidate must possess strong leadership skills, hold a Certified Professional Coder (CPC) certification, and demonstrate a proactive approach to establishing policies, procedures, and follow-up.
**Key Responsibilities:**
1. **Leadership and Team Management:**
- Provide strong leadership and direction to the billing department.
- Supervise, train, and mentor billing staff to ensure high performance and professional development.
- Conduct regular team meetings to communicate updates, address issues, and promote a collaborative work environment.
- Evaluate staff performance, provide constructive feedback, and implement improvement plans as needed.
2. **Billing and Coding:**
- Oversee the entire out of network billing process, including charge entry, claims submission, payment posting, and account receivables.
- Ensure accurate coding of diagnoses, procedures, and services performed by healthcare providers in accordance with CPC standards.
- Monitor and audit billing processes to ensure compliance with federal and state regulations, as well as payer requirements.
- Resolve coding discrepancies and billing issues in a timely manner.
3. **Revenue Cycle Management:**
- Manage the revenue cycle to optimize financial performance and cash flow.
- Analyze billing data and generate reports to identify trends, opportunities for improvement, and potential areas of revenue leakage.
- Implement best practices to improve billing efficiency, reduce denials, and expedite claims processing.
- Collaborate with other departments, such as finance and clinical operations, to align billing practices with overall practice goals.
4. **Policy and Procedure Development:**
- Establish, implement, and maintain billing policies and procedures to ensure consistency and compliance across the practice.
- Continuously review and update policies and procedures to reflect changes in regulations, payer requirements, and best practices.
- Ensure that all billing staff are trained and adhere to established policies and procedures.
5. **Follow-Up and Compliance:**
- Implement strong follow-up procedures to ensure timely resolution of unpaid claims and outstanding balances.
- Stay current with changes in billing regulations, coding guidelines, and payer policies.
- Ensure that the billing department adheres to all compliance standards, including HIPAA.
- Maintain accurate and up-to-date billing records, documentation, and coding manuals.
- Conduct regular internal audits to verify compliance and accuracy of billing activities.
**Qualifications:**
- Certified Professional Coder (CPC) certification preferred .
- Bachelor's degree in healthcare administration, business, or a related field preferred.
- Minimum of 5 years of experience in medical billing and coding, within an OUT OF NETWORK environment with at least 2 years in a supervisory or managerial role.
- Strong knowledge of medical billing software, electronic health records (EHR), and practice management systems.
- Excellent leadership and team management skills.
- Strong analytical and problem-solving abilities.
- Excellent communication and interpersonal skills.
- Detail-oriented with a high level of accuracy in work.
- Ability to work independently and collaboratively in a fast-paced environment.
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