Medical Business Office Manager

Position: Medical Business Office Manager, Full Time
Location: Chipley

Medical Business Office Manager, Full Time

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Job Summary

Provides managerial leadership for hospital business office functions that contribute to the billing and collection of patient service revenue. Responsibilities include best practices and principles related to patient accounting, insurance reimbursement, governmental and other payer source billing, credit and collections and cashiering related to hospital and long-term care services. Knowledge of functions, capabilities and operation of computer-based billing and patient accounts management systems, including but not limited to CPSI (EHR), Quadax or similar (Clearinghouse) and Microsoft applications (Word, Excel, Power point, etc.).

Education

Associates degree from an accredited college or university required; a bachelor’s degree in business, finance, accounting, management or closely related discipline is preferred.

Experience

A minimum of five (5) years management experience in healthcare receivables required. Work record that demonstrates in-depth knowledge of hospital and long-term care billing and reimbursement, knowledge of medical terminology, negotiating skills, and knowledge of healthcare industry financial statistical information.

Licenses, Certifications and/or Registrations

None.

Specialized Knowledge and Skills

Principles and practices of patient accounting, insurance reimbursement, governmental and other payer source billing, credit and collections and cashiering related to hospital and long-term care services. Knowledge of functions, capabilities and operation of computer-based registration, billing and patient accounts management systems. Requires sufficient knowledge in the use of basic computer software. Must use software to develop spreadsheets for analytical purposes.

Supervised by

CFO, COO and CEO

Supervises (Headcount)

6 - 10

Supervises (Job titles)

Patient Financial Services associates

Interrelations/Contacts

Works with all departments on accounting and/or human resource issues.

Essential Functions Of Competent Performance

• Demonstrates in-depth knowledge of hospital and professional billing to ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payors. A deep understanding of how a CAH (Critical Access Hospital) operates as it relates to insurance and financial matters.
• Demonstrates up-to-date knowledge related to CMS guidelines, ICD-10 requirements, UB/1500 claim submission data and elements required for clean claim submissions.
• Manages billing operations that cover all aspects of government payers, third party and patients to ensure accurate and timely processes occur.
• Ability to analyze and resolve problems that affect the claim submission process, regardless of whether the problem originates in an area under direct or indirect control.
• Satisfactorily mediate and resolve conflicts regarding billing inquiries from patients and/or third party payors. Implement patient friendly billing guidelines.
• Maintain appropriate internal control safeguards over AR records and collection of cash. Maintain compliance standards for providing accurate information on hospital billing system.
• Has a good understanding of how insurance contracts work between hospitals/health systems and third party payers.
• Has a good understanding of how government payers adjudicate and process claims. A solid understanding of the various payment methodologies from Medicare and Medicaid is critical.
• Promptly audit remittance advices to ensure timely and optimal payment. Communicate deficiencies to applicable department managers to resolve issues related to uncollected revenues.
• Ensure timely collection of AR to maintain consistent cash flows. Maintain days in AR at acceptable level (e.g. 45 day.
• Provide decision support [generate reports] to financially analyze data to identify trends and/or variances with regard to billing and collections. Make procedure changes as necessary.
• Develop billing and collection policies, procedures and standards that promote “best practice” guidelines that improve productivity and…