Billing Team Leader

Job responsibilities include, but are not limited to:

• Supervise and manage all billing operations, which include all forms of Medicaid, Medicare, Managed Care and Third-Party Insurance. • Utilize all available resources (eMedNY, Inovalon, Availity, AWARDS and various payer portals), as well as work with program administration to obtain billing documentation, insurance information, etc. as needed to accurately process/adjudicate claims. • Oversee the entire claim’s lifecycle from charge entry, claim submission, payment posting to denial management and appeals. • Understand the operational details of the billing process internally, including claim processing, revenue projections (cash flow), payment posting, claim follow-up and client/consumer third-party collections as necessary. • Maintain medical billing record files (electronic or hard copy, as necessary) and ensure accuracy of coding for claims submissions. • Manage denied claims, resolve discrepancies and work with program administration to rectify denied claims (including developing reports to analyze/track denied claims and progress through resolution). • Maintaining an ongoing relationship with payers, understanding their billing guidelines and procedure for appealing denied claims. • Responsible for keeping track of changes in procedure codes, rate codes and amounts as they may change several times during the year. Keep apprised of rules and regulations affecting coding and reimbursement. • Produce and analyze accurate Accounts Receivable Aging Reports and advise Senior Fiscal Director-Residential & Billing of potential bad debts. • Seek and recommend ways to improve operational, billing efficiency and compliance with federal, state and payer regulations. • Serve as the primary liaison between clinical providers, program administrative staff, and the billing department to resolve workflow bottlenecks. • Supervise, manage and mentor billing staff. Monitor performance, ensuring quality and productivity levels are maintained. • Assist the billing staff in a prompt and professional manner with troubleshooting billing and coding issues. • Ensure staff receives initial training and educational opportunities and maintain training as necessary. • Hire, counsel and recommend disciplinary action as necessary. • Be responsible for providing auditors with all requested billing reports at year end. • Provide information as requested to supervisor, management or co-workers in a timely manner. • Serve as back-up for any member of the Billing team. • Maintain an accurate inventory of billing files and have them destroyed as per Agency’s disposal policy.

The ideal candidate will: • be detailed oriented. • be able to work independently and take initiative. • have knowledge of Medicare and Medicaid regulations. • have a thorough knowledge of Microsoft Excel and the ability to create and maintain spreadsheets. • have experience with AWARDS software. • have experience with Millin billing software. • have an understanding of medical coding systems affecting the adjudication of patient accounts in EDI, UB04 or 1500 forms. • have experience with third-party claim resolution processes, including denials and appeals management. • have the ability to multi-task and meet deadlines. • possess effective oral and written communication skills. • have the ability to interact effectively with all levels of employees, as well as external contacts. • be able to handle confidential and sensitive information. • require manual dexterity for the use of a computer, telephone, fax or copy machine. • be able to prepare clear, concise reports. • be able to plan, assign and direct the work of others. • be able to communicate effectively orally and in writing • support the mission, values and vision of the organization. • promote positive public relations with residents, family members and guests. • complete requirements for in-service training, acceptable attendance, uniform and dress codes, including personal hygiene. • be able to solve complex problems and deal with a variety of issues. • possess the ability to effectively present information and respond to questions from managers, employees, residents, families, professionals and the general public. • possess the ability to communicate sensitive information to principals and clients. • be able to lift items up to 25 pounds. • Be able to sit or stand as needed, with or without reasonable accommodation. • May require walking, primarily on a level surface, for short periods throughout the day, with or without reasonable accommodation. • Be able to reach above shoulder heights, below the waist or lift as required to file documents or store materials throughout the workday, with or without reasonable accommodation. • During a declared disaster, assume and adhere to assigned Job Action role(s) consistent with Disaster Preparedness Plan. • Attend job and Agency trainings as required to maintain compliance and ensure continued professional development. • Perform other related duties as required. Experience/Education/Skills/Abilities Bachelor’s degree in Business, Healthcare Administration or commensurate experience in healthcare industry plus 5–7 years’ progressive work experience in medical billing and revenue cycle management with a minimum of 2-3 years in behavior health or psychiatric setting. Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) preferred. Previous management experience required. Accounting/Finance degree a plus. Minimum qualifications may be waived in unusual circumstances with approval of the CEO as long as City and State requirements are met.