Billing & Reimbursement Manager

ESSENTIAL FUNCTIONS AND BASIC DUTIES:

Supervisory-Specific Performance Expectations, Duties, and Responsibilities:

• Demonstrates 100% commitment to high performance in accordance with the CHOICE values of MRH and represents the organization in a positive and professional manner.
• Provide direct supervision to the billing staff, ensuring performance expectations are met, including training and onboarding of new staff to ensure proficiency in the billing processes.
• Foster a collaborative and accountable work environment.
• Conduct regular staff meetings to communication updates, policies, and goals.
• Develop training programs to ensure staff remains current on billing regulations, payer policies, and claim submission best practices.
• Conduct employee evaluations, bi-weekly timesheet approvals, and attend monthly management meetings.

Position-Specific Performance Expectations, Duties, and Responsibilities:

• Oversee the accurate and timely submission of claims for inpatient, outpatient, and professional services.
• Ensure compliance with healthcare regulations, including HIPPA, CMS guidelines, and other relevant laws and standards.
• Stay updated on changes in healthcare regulations and payer requirements that impact the revenue cycle.
• Analyze denials, implement corrective actions, and oversee the appeals process to maximize reimbursement.
• Review and correct claim edits to ensure compliance with payer regulations while minimizing denials and billing errors.
• Collaborate with departments such as Registration, Coding, and Finance to develop and implement process improvements.
• Ensure timely management of old and/or uncollectible accounts including bad debt with regular reviews, appropriate write-offs, and implementation of strategies to minimize future occurrences.
• Member of the RAC team. Must have a general understanding of the RAC program. The team establishes processes and procedures to manage audits and verify Work closely with the Compliance Officer on Revenue Cycle related issues as requested.
• Conducts internal audits pertaining to work queue management. Review and evaluate Make recommendations based on these results to improve revenue, workflows and/or compliance regulations.
• Identify opportunities to optimize revenue capture and minimize revenue leakage.
• • Conduct and review audits on current denials to determine root causes and identify patterns or trends.
  • Provide monthly detailed reporting statistics to the Revenue Cycle Director and CFO on KPIs.
  • Demonstrates a professional, positive and caring attitude.
  • Works closely with other departments, including, but not limited to registration, prior authorization, and coding.
  • Performs other duties as assigned.

• QUALIFICATIONS:

  Minimum Requirements:

  • Must be at least 16 years of age (21 for driving positions with a valid driver’s license).
  • Must be able to legally work in the United States.
  • Must be able to pass a background check.
  • Must be able to pass a drug screen and breath alcohol test (if applicable).
  • Must complete employee health meeting.
  • Excellent analytical, organizational, and communication skills.
  • Extensive knowledge in CAH and RHC billing and coding practices.

   

  Required Education/Licensure/Certification:

  • Bachelor’s Degree in Healthcare Administration, Finance, Accounting, or a related field required.
  • Minimum of 5 years of experience in healthcare revenue cycle auditing, billing, coding, or related field required.
  • Proficiency in Microsoft Excel required.
  • Minimum of 2 years of experience in a Critical Access Hospital and Rural Health Clinic Revenue Cycle role.
  • Strong leadership, problem-solving, and communication skills with the ability to manage a team effectively required.

  Experience:

  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification preferred.
  • Proficiency in EPIC preferred.
  • Strong understanding of UB-04 and CMS-1500 claim forms required.