Working title: Medical Billing Manager

Classification title: Program Manager 1

Reports to: Senior Director of Fiscal Services

Program: Fiscal Services

FLSA status: Exempt; Full-time

Schedule: Monday-Friday

Wage Range: $52, 298 to $70,756 annually; depending on number of years of transferrable experience and internal equity

Organizational Overview:

Serving the Yellowstone County community and south-central Montana for nearly 50 years, RiverStone Health is an essential provider of personal and public health services. Health, Education, Leadership and Protection – HELP is what we do.

From medical, dental and behavioral healthcare; home care and hospice; public health services like immunizations, WIC, health promotion and restaurant inspections; and educating the next generation of health professionals, our expertise spans all ages and stages of life. Underlying principles of access, affordability, compassion and quality in all interactions, RiverStone Health improves life, health and safety for all of the communities we serve.

Foremost, we are committed to the values of Justice, Equity, Diversity and Inclusion (JEDI) by cultivating an environment that protects and acknowledges the unique identities within our diverse community.

Job Summary:

The Medical Billing Manager manages the daily operations of billing/coding department and provides coaching, mentoring, and supervision to staff. They bring content expertise and knowledge surrounding the program elements, deliverables, and metrics, including focus on compliance and quality improvement initiatives. This position will report to the Senior Director of Fiscal Services and will manage all activities and staff in the billing/coding function.

Essential Functions/Major Duties and Responsibilities:

(The individual must be able to perform the essential functions of the job. This is not an inclusive list of all duties the incumbent will perform. The percentages of time spent for each area will fluctuate. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions.)

Each job description consists of A) core duties performed by the occupational classification, and B) department or discipline specific duties performed by individual positions. Managers may customize this job description template by removing core duties that are not applicable and/or adding duties specific to the program or position. If more than 50% of the work performed by a specific position differs from this core job description, the manager should contact Human Resources to determine if an alternative classification is appropriate.

A. Program Management 60%

• Assess program and client needs and ensure that program objectives are met.
• Work with community members and other stakeholders to identify necessary programs and services.
• Identify, suggest, or implement improvements to programs and services.
• Plan and oversee outreach activities.
• Review, interpret, and monitor compliance to guidelines, laws and regulations.
• Prepare reports.
• Provide training or technical assistance to partners
• Investigate complaints and suspected violations.
• Coordinate activities of program committees or other groups and plan procedures.

B. Medical Billing Manger Specific Duties 35%

• Assist the Senior Director of Fiscal Services in developing, implementing, and revising departmental policies and procedures.
• Oversee the current status of patient accounts and assists in identifying and resolving billing and processing problems.
• Serve as the subject matter expert in FQHC billing, including being responsible for researching new or changing requirements related to documentation, coding and billings practices.
• Attend eCW Advisory committee and other pertinent meetings to provide input on billing practices and new rules/regulations.
• Work with IT and Informatics personnel to assist in finding solutions to billing errors between provider documentation in the EHR and how its’ transferred to the practice management system.
• Analyze billing processes and designs, as well as recommend and implement methods of improvement.
• Review and make appropriate coding/billing changes for encounters identified by various daily reports that come from IT; i.e., Medicare patients with multiple visits on the same date, procedure clinic visits, telemedicine visits, etc.
• Monitor and review Medicare listserv notifications, Medicaid provider notices, Medicaid claim jumper, and other publications for new/changing billing/coding rules and regulations and advise appropriate personnel of any impact to billing processes.
• Monitor rejected or denied claims to determine the cause. This analysis will be used to train providers and staff.
• Monitor open or outstanding claims, proactively identifying and resolving problems.
• Monitor payment posting to ensure accuracy and that payers are paying according to established contracts.
• Develop and maintain audit processes to ensure complete documentation, coding accuracy, and appropriate reimbursement.
• Upload patient receivable information for monthly statement generation preparation.
• Run month-end reports, including, but not limited to, aging summary analysis, charge and payment reports, and adjustment reports, and review reports to identify and address any collectability issues, identify accounts in need of being turned over to outside collection agency, and ensure accounts are being reviewed for any other issues.
• Supervises assigned billing / coding personnel.
• Conducts training, orientation, and performance evaluations.

Non-Essential Functions/Other duties as assigned 5%

(Functions performed either very infrequently or that could be performed by others without altering the underlying reason the job exists.)

• Perform other duties as assigned in support of the RiverStone’s mission and goals.

Education and Experience:

(List education, years of experience, certifications, licenses & registrations needed by an individual to perform the essential functions on the first day of employment or the minimum requirements that must be present at the time of hire. Do not include education or experience developed through on the job training after hire).

Minimum Qualifications

• High School diploma or equivalent
• Considerable accounting or medical bookkeeping experience, or
• Any combination of experience and training which provide the equivalent scope of knowledge, skills, and abilities necessary to perform the work.

Preferred Qualifications:

• 5 years experience in related field as an individual contributor
• 1-3 years supervisory experience
• Experience in community education or presentations
• Experience in federally qualified health center billing / coding or with underserved population
• Experience in hospice and homecare billing.

Certificates, Licenses, Registrations:

• Valid State of Montana Driver’s License in good standing

Knowledge, Skills, and Abilities:

(Examples include: 1) Computer literacy, including Excel, Outlook and Word. 2) Knowledge of modern office procedures, practices and equipment. 3) Ability to maintain a calm and positive demeanor during difficult client interactions. 4) Ability to display non-judgmental and empathetic listening skills. 5) High degree of detail-oriented level of skill. 6) Knowledge and understanding of protected sensitive patient health information (HIPAA) and confidentiality. 7) Ability to work collaboratively and maintain a positive work environment. 8) Ability to meet deadlines.)

• Working knowledge of coding requirements
• Understanding of Federal, State, and Local legal compliance & regulatory provisions related to billings practices
• Computer literacy, including Excel, Outlook and Word
• Analytical/Assessment Skills
• Policy Development/Program Planning Skills
• Communication Skills
• Cultural Competency Skills
• Financial Planning and Management Skills
• Leadership and Systems Thinking Skills
• Knowledge and understanding of protected sensitive patient health information (HIPAA) and confidentiality.

Customer Service Excellence:

(Provides Customer Service Excellence to RiverStone Health’s customers, including patients, clients, family members, visitors, medical staff, and co-workers.)

• Doing things right the first time
• Making people feel welcome
• Showing respect for each customer
• Anticipating customer needs and concerns
• Keeping customers informed
• Helping and going the extra mile
• Responding quickly
• Protecting privacy and confidentiality
• Demonstrating proper telephone etiquette
• Taking responsibility for handling complaints
• Being professional
• Taking ownership of your attitude toward Service Excellence.

Supervision:

(List number of FTE, job titles & work units supervised.)

• Number FTE Directly Supervised: 5
  • Titles of Direct Reports: Certified Coders, Accounting Technicians
• Number FTE Indirectly Supervised: 0
  • Titles of Indirect Reports:
• Work Units Supervised:

Physical Demands and Working Conditions:

(List the physical location(s), travel requirements and physical demands and conditions the employee is required to do while performing the essential functions of the job.)

[Examples: 1) Work is mainly performed in a clinic setting. 2) Work in outreach settings including outdoors and at community events. 3) Standing, bending, sitting, lifting required. 4) Required to travel to different clinic locations 1-2 times per month. 5) Required to wear N95 mask.]

• Standing, bending, sitting, lifting required
• Required to travel to different clinic locations
• Create and maintain a safe/secure working environment by adhering to safety, security, and health requirements. Integrates injury, illness, and loss prevention into job activities by attending any necessary training and implementing best practices.

Freedom to Act & Decision Making:

(Depth of control, supervision received, and the degree of judgement, initiative, and discretion exercised when performing the essential functions of the job.)

[Example: Responsible for the service of 20-30 clients per day; supervised by section manager; uses independent judgment; has someone readily available to ask questions if needed.]

Communications & Networking:

(Liaison with others, type and level of communications.)

[Example: Daily written and verbal communication with patients, patient family members, co-workers and providers.]

Budget & Resource Management:

(Scope of budget authority, program funding types and guidelines, forecasting, FTE resources) Complete only if position is responsible for budget and FTE resources.

[Example: Program funded through a combination of 3 grants; $500,000 annual budget; Program supported by 4 FTE.]

• Not applicable

Behaviors

• Dedicated: Devoted to a task or purpose with loyalty or integrity
• Functional Expert: Considered a thought leader on a subject
• Leader: Inspires teammates to follow them

Motivations

• Self-Starter: Inspired to perform without outside help
• Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)