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Position Title: CBO Billing Manager
Department: Patient Financial Services
Reports to: Assistant Director, Patient Financial Services
Qualified Candidates Must Have:
Education: High School Diploma or Equivalent Experience: Five (5) years’ experience in all types of (healthcare) insurance billing including electronic transmission of claims and one (1) year supervisory experience
Skills and Knowledge: Manages staff through positive reinforcement that motivates and instills confidence; typing and computer experience; verbal and numerical intelligence; ability to interact with the public; ability to motivate people and utilize resources in an organized manner; understanding of Medicare reimbursement.
Position Purpose:
All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision of providing the region’s best clinical care and patient service through an environment that fosters respect for others and pride in performance.
CBO Billing Manager is responsible for the billing of all hospital and clinic government and commercial insurance and third party payer claims in a timely, accurate manner, as required by insurance companies to effect rapid payment. The Manager supervises and coordinates activities of personnel in the billing department, credentialing, and clinic referrals. The Manager oversees the maintenance of records, files and reports in accordance with KHI standards. This position ensures that that KHI Health Information Systems are operating appropriately in relation to billing, credentialing and clinic referrals. Key Responsibilities
Regularly directs the work of two or more full time employees. Has authority to hire, fire and counsel staff. Interviews and selects personnel, recommends promotion, disciplinary action, and termination of employees as needed. Handle employee complaints and grievances.
Keep current and advise billers of all changes of CPT4, ICD9 and HPCS codes in order that claims may be paid correctly; notify credit personnel of invalid insurance or limitation of coverage; investigate and resolve any billing discrepancies; provide back-up billing assistance to billing clerks
Works closely with other Department Managers in respect to issues that arise effecting other departments Plans, organizes, coordinates, and controls the systems by which patients billing, provider credentialing, and clinic referrals information is developed, processed and maintained Monitors and evaluates the quality of the department and takes appropriate action based on the findings Develops and revises job descriptions for all department positions; interviews, selects and hires new or replacement staff to fill approved positions
Effectively utilizes employee improvement and corrective action methods when necessary; schedules work hours and assignments for employees to meet the needs of the Department’s customers; administers hospital and department policies and procedures; completes employee appraisals
Provides opportunities for self and staff development through orientation, education, and training; maintains professional qualifications and remains abreast of current developments and trends in billing and reimbursement processes including billing
Provides/coordinates community and education programs as needed; responds to physician requests and the Medical Staff personnel
Assesses current volumes, and projects/plans for future service needs; establishes operational goals and objectives; evaluates achievements at least annually
Randomly audits billing, credentialing, and referrals using sampling techniques to ensure accuracy; coaches employees for improvement where necessary based on predetermined parameters; ensures that insurance requirements are obtained as required and that insurance authorizations are effective during the admissions process; deals with insurance company provider representatives when issues effecting cash flow arise
Develops and implements policies and procedures for the department
Preferences
Education: Bachelor degree in business or related field
Experience: Preferably in a hospital or similar institution
Special Position Requirements
Blood Borne Disease Exposure Category: Category III Work Requirements
Ability to sit for six to seven hours daily at a computer terminal; occasionally lifts and carries up to 15 pounds of files to storage area. Date Staff Position Description Created / Revised: 10/2012; 04/2019