SCOPE / GENERAL PURPOSE OF JOB:
Responsible for managing the daily functions of charge entry/demo specialists in accordance with RC Billing Standards and Reimbursement policy and procedures. Including timely and accurate charge entry, generation and distribution of weekly and monthly charge reports, review of sample charges weekly to ensure accuracy, problem solving and efficiency improvement to the business office operations while ensuring client satisfaction.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Demonstrates thorough understanding of the demographic and charge entry function compliant with Federal and State regulations and RC Billing policy and procedures.
- Reviews daily accuracy of charges posted by RCB staff and ensures clients weekly reports are up to date and balance daily.
- Ensures each week/Wednesday that the clients Weekly Reports are balanced and uploaded to Share File for each client.
- Ensures each week/Friday that the clients CCL (Client Communication Log) has been updated and disseminated to the client for actions to be taken. Any nonresponse from clients are reported immediately to the Director of Operations.
- Assists RCB staff to ensure timely daily resolution of any demographic and/or charges submitted lacking necessary information to allow entry.
- Daily maintains a Charge report per client ensuring charges are received at a minimum weekly and all charge totals are listed and balanced. Reports weekly to the Director of Operations and President a listing of any clients that have not submitted charges per their schedule, daily or weekly.
- Makes direct contact with clients when charges are not received timely as expected.
- Notifies Revenue Cycle IT Dept. and management of any system issues encountered. i.e. VPN access to clients EMR (MOSAIQ, ARIA, etc…), HL7 ADT or DFT Interfaces, AccelaSMART, Allscripts
- Maintains working day to day knowledge of the practice management systems.
- Maintains strong working knowledge of Radiation and Medical Oncology coding to include payor specific billing requirements.
- Updates job knowledge by participating in educational opportunities. (Allscripts, AccelaSMART & Radiation and Medical Oncology Coding)
- Ensures strong communication with other CBO management team members.
- Maintains working knowledge of applicable laws and regulations as they relate to assigned responsibilities.
- Maintains confidentially of all information related to patients, medical staff, finances, RCB policy and procedures and cost effective health care delivery issues.
- Maintains confidentiality of assigned logins and passwords to access clients EMR’s.
- Strives to achieve CBO goals and benchmarks.
- Demonstrates the ability to work well with peers while ensuring a strong cohesive team.
- Directs the daily operation of the charge entry/demo specialists to ensure accuracy and timeliness in all areas of responsibility.
- Ensures that daily, weekly, and monthly billing functions are performed and accurate.
- Working directly with the RCB Director of Operations scheduleing month-end system closes; ensures that all departmental areas meet cutoff deadlines and generates monthly management reports from system.
- Ensures that charge entry is in balance with applicable clients prior to month end close processes.
- Oversees daily communication between CBO billing team and client practices.
- Communicates with client as necessary with a minimum of monthly. Communications may include physicians, administration and business departments. Attends monthly conference calls with clients to discuss the prior month’s financials, issues identified, issues resolved, etc.
- Implements and ensures compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency. Ensures compliance with appropriate industry regulations and State and Federal regulations.
- Recruits, hires and supervises charge entry and demo specialists staff; assists with developing and attaining performance goals and objectives. Evaluates performance and recommends merit increases, promotions, and disciplinary actions.
- Completes QA audits for each Demographic Specialist and Charge Entry Specialist at a minimum of quarterly.
- Provides training to demographic and charge entry specialist and provides documentation of training to HR.
- Ability to respond to common inquiries or issues from payors
- Strong knowledge of healthcare reimbursement, coding, and billing procedures.
- Must possess strong interpersonal skills and ability to work with individuals across all organizational levels.
- Must possess excellent oral and written communication skills
- Must possess excellent organizational skills
- Must possess excellent time management skills to ensure time lines are obtained
- Ability to read, analyze, and interpret technical procedures and/or government regulations.
- Ability to write reports, business correspondence, and assist with CBO policy and procedure manuals.
- Other duties as assigned.
EDUCATION AND/OR EXPERIENCE:
- High school diploma or equivalent
- Bachelor’s degree preferred.
- Minimum seven (7) years medical office management experience.
- Knowledge of fiscal management and human resources management practices. Knowledge of organization policies and procedures.
- Knowledge of health care administration principals.
- Knowledge of business office procedures.
- Previous direct management experience required.
- Knowledge of insurance agency operating procedures and practices.
- Skill in exercising initiative, judgment, discretion and decision -making to achieve business unit objectives. Skill in identifying and resolving problems.
- Ability to communicate effectively regarding fiscal policies.
- Ability to establish and maintain effective working relationships with all employees and clients.
- Knowledge of CPT-4 and ICD-10 coding.
- Knowledge of Allscripts Misys Tiger, Allscripts Pro PM, and Practice EDI Insight preferred.
- Ability to communicate effectively and professionally orally and in writing.
CERTIFICATIONS / LICENSURES / CREDENTIALS: None
SUPERVISORY RESPONSIBILITIES: Yes
The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position requires full range of body motion including manual and finger dexterity and eye-hand coordination. The position additionally requires standing/sitting for extensive periods of time. Occasional lifting and carrying items weighing up to forty (40) pounds may be required. Requires corrected vision and hearing to normal range.
The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment involving frequent interaction with staff, clients and the general public.