Summary: Manages all billing and collection activities in the Business Office including coding, billing, payments, collection, credentialing and malpractice. The Director of Business Services works collaboratively with senior management team, carriers, clients, clinics and other departments to ensure services delivered are aligned with business needs, while planning, organizing, and managing both resources and processes in order to achieve operating efficiency and revenue growth.
Duties and Responsibilities (includes, but is not limited to the following):
Assists CEO, Director of Finance and Director of Regional Operations in maintaining billing and collection targets within industry standards and company objectives.
Establishes and recommends policies and procedures. Makes recommendations for improvements.
Develops management and trending reports to show efficacy of billing, coding and collection efforts.
Coordinates efforts for timely month end billing close.
Manages A/R, collections
Regularly audits documentation and coding to assure compliance with Medicare and industry guidelines/standards.
Evaluates performance and recommends merit increases, promotions, disciplinary action and communications regarding the business office.
Works with Director of Finance and IT to update and evaluate needs of computer system.
Ensures compliance with governmental regulations and standards of performance in management of billing staff and billing and collection of medical charges.
Maintains knowledge of health care capitation and reimbursement trends and practices.
Serves as the company’s Compliance Officer regarding billing compliance and HIPAA.
Monitors effectiveness of collection efforts and maintains insurance billings are current within the established time frame specified in the department policy.
Manages licensing compliance requirements and CLIA/State Laboratory Permits.
Interprets payer contract language, understands contract details and major provisions of agreements as they relate to day to day operations (e.g., timely filing limits, retroactivity, refunds, rate schedules, term notices, credentialing requirements, etc.).
Assures compliance with regulatory requirements and product requirements in relation to provider contracting functions.
Oversees professional credentialing to ensure that employed physicians and mid-levels applications are completed with third-party payers and hospitals.
Provides oversight of all credentialing and re-credentialing functions adhering to established processes and timeframes.
Develops a thorough understanding of systems, processes and payer specific reimbursement mechanisms and billing requirements, contributing in the proactive identification of opportunities for revenue cycle improvement and enhancement.
Manages relationships with various consultants, vendors, and collection agencies that support the collection process.
Directs and oversees development plan for reimbursement and claims leaders and staff, ensuring that it meets objectives.
This position oversees Business Office Department Managers, Contracting and Credentialing Department, and Payment Processors. Five direct reports and department of 25.
Education, Licensure and/or Certifications
Bachelor’s Degree in Health Care Administration, Business or a related field, preferred.
AAPC or AHIMA Certified
Minimum five years’ experience in progressively responsible management positions in the health care industry.
Knowledge, Skills and Abilities
Proficiency in medical billing and accounting.
Maintains a thorough understanding of health care patient systems, including fee schedules capitated and managed care contracting issues, etc.
Skill in negotiating and procuring services from outside agencies and vendors and insurance.
Extensive knowledge of medical office procedures, CPT, ICD-10, HCPCS coding, and insurance company operating procedures.
Thorough knowledge and understanding of all facets of providing services to Medicare patients.
Work Environment: The work environment characteristics described here are representative of those an employee may encounter 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 and requires both desk and counter work. Frequent contact with employees, physicians, patients, and outside agencies.
Additional Salary Information: Performance based (company and individual) bonus: 8 - 10%.
Relocation Assistance: up to $7500.00
Internal Number: HR_1001
About Northern California Medical Associates
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