Enrollment & Billing Representative is responsible for the accurate enrollment and billing process for an insurance organization. Maintains related documents, updates corresponding records and responsible for enrollment and billing query. Being an Enrollment & Billing Representative requires a high school diploma or its equivalent. Typically reports to a supervisor or manager. The Enrollment & Billing Representative possesses a moderate understanding of general aspects of the job. Works under the close direction of senior personnel in the functional area. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)
Description
Salud Para La Gente (SALUD) provides high quality, comprehensive and cost-effective healthcare to underserved low-income communities in the Monterey Bay area, including Santa Cruz County and North Monterey County. We began in Watsonville 1978 as a storefront “free clinic,” and with the ever growing need for health services, in 1992 became a federally qualified community health center (FQHC). Today we are a primary health care network with 11 clinic sites and over 400 employees and continue to provide high quality services to patients of all ages.
SALUD offers a competitive salary and benefits package and a collaborative culture that values excellence, achievement, innovation and compassion.
We are seeking a dynamic, organized and detail-oriented Billing Manager. Under the supervision of the Controller, the Billing Manager will be responsible for supervision of the billing staff, as well as ensure all areas of the billing department run smoothly. The Billing Manager will work in coordination with the Controller to ensure accuracy and the proper processing of all billing functions.
This position supports the organization's mission, vision, and values through excellence and competence, collaboration, innovation, respect, commitment to our community, and accountability and ownership.
Requirements
DUTIES AND RESPONSIBILITIES:
1. Oversee daily billing department, accounts receivables and credentialing activities.
2. Supervise billing clerks, billing leads, accounts receivable specialists, and credentialing coordinator including performing evaluations and making recommendations for career development.
3. Maintain patient accounts receivable aging; review aging report and KPIs with the billing staff routinely to ensure aging goals are met and recommend changes based on trends.
4. Evaluate billing errors and provide updates and training recommendations to Controller and billing leads.
5. Regularly meets with Controller to provide updates and recommendations regarding departmental performance.
6. Analyze and maintain appropriate billing procedures and accounts receivables procedures to insure compliance of fiscal policies.
7. Analyze and maintain optimal accounts receivable workflows and performance to meet agency needs.
8. Oversee credentialing coordinator’s tasks, workflows and deadlines to insure agency needs are met.
9. Conduct meetings on a regular basis with the billing staff to discuss any procedural changes, as well as provide updates regarding health insurance billing or state funded programs.
10. Conduct monthly individual meets with billing clerks, billing leads, accounts receivable specialists and credentialing coordinators to discuss workflow, goals and development.
11. Prepare and evaluate a variety of departmental data reports in order to analyze the billing functions, accounts receivables and credentialing status and make recommendations to Controller as needed.
12. Maintain open communication with the billing department, accounts receivables and credentialing and remain up-to-date and knowledgeable of all billing activities.
13. Maintain interdepartmental communication regarding billing related issues.
14. Analyze work flow and provides recommendations to Controller for improvements as needed.
15. Provide training and support for revenue cycle staff as needed to ensure billing accuracy and efficiency.
16. Work with Data Services department and Systems to adhere to programs required for reporting and billing functions.
17. Oversee daily revenue cycle interdepartmental activities.
18. Attend, conduct and/or facilitate interdepartmental meetings to optimize workflows for all departments involved in revenue cycle.
19. Create and update trainings and documentation related to billing for interdepartmental trainings.
20. Analyze workflows of interdepartmental activities and make recommendations to controller and appropriate committee.
21. Identify and monitor compliance of coding and billing of all interdepartmental functions, services, supplies, medications and overall other revenue cycle related areas.
22. Review new and existing coding and pricing request for existing and current programs/services.
23. Assist with training to new and existing clinical providers.
24. Provide training and support for revenue cycle staff as needed to ensure billing accuracy and efficiency.
25. Coordinate training and support for billing lead and billing clerks with state programs, specialty programs and third party payers.
26. Ensure a productive work environment and achievement of goals through strategies and practices in line with the CARE fundamentals of communication.
27. Respond to co-worker and patient needs in ways that are helpful and beyond expectation.
28. Perform a variety of office support and general clerical duties as needed.
29. Perform other duties as assigned.
EMPLOYMENT STANDARDS:
Knowledge of: Basic and computerized billing procedures, especially relating to billing of insurances and state and federal programs.
Ability to: Use basic math accurately; prepare reports; learn and draft new policies and procedures; organize work efficiently, using sound independent judgment; think independently and analytically; use a variety of standard office and computer equipment; communicate effectively and respectfully with a diverse group of individuals and clients, demonstrating a knowledge of and sensitivity to their needs; develop and maintain effective working relationships with Salud Para La Gente staff, patients, health insurance companies, government, and community agency representatives, and the public; and manage billing staff.
MINIMUM QUALIFICATIONS:
· Bachelor’s Degree in business administration or health related field or 5 years
health insurance billing experience.
· Two years experience working with the following state programs and rules:
MediCal
- Medicare
- Child Health Disability Program (CHDP)
- Family Pact
- Healthy Families
- Bilingual Spanish/English.
- Minimum of two years of supervisorial experience.
- Proficient in Microsoft Office including Outlook, Word and Excel
- One year experience with standard ICD-10 medical and dental coding (experience
to have occurred within the past two years).
PHYSICAL DEMANDS:
· Standing, walking, sitting, typing, reaching, bending, moving and/or lifting up to 50 pounds.
SALARY & BENEFITS
Salary Range: $84,771.90-$103,040.77 per year
Benefits package includes Medical, Dental, Vision, and Life insurances, Voluntary Life Insurance, Voluntary Long Term Disability, 401(k) with match, PTO and 12 paid Holidays.
**Salud is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Salud is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact the Salud Human Resources Department, [831-728-8250, and HRDept@splg.org].**
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