Dir, Billing Hospital & Physic

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Billing Director is responsible for leading and planning within the billing departments to oversee and streamline billing processes, staff development, and exceptional internal/external department relations. Ensures billing practices are consistent with internal policies and external requirements of payors. Enforces a collaborative approach across the system to ensure an integrated approach to meet billing requirements/goals.

Direct all applicable hospital and physician billing job functions as stated in organizational and departmental policies and procedures. Responsible for overseeing the research, analyzing, resolving and trending of billing rejections. Responsible for providing direction and oversight of the Billing team while overseeing claim preparation, claim submission and billing edit functionality system wide.

Provide functional guidance to billing staff in supporting areas of operations. Ensure all billing/payor edits and reason/remark codes are continually updated. The Director will maintain appropriate files, reports and other statistical data as required. Ensures that the activities of billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State and payer regulations, guidelines, and requirements.

Responsibilities

1. Oversee in-house resources & billing tools and/or third-party vendor to ensure accurate coding and submission of claims; improve claim submission process to increase automation, first pass rates, and collections.
2. Implement best practices for billing operations, system implementations, and continually assess and improve processes.
3. Utilize claims data to work with the Patient Access Services Director to manage our eligibility software tool and/or vendor to improve accuracy of eligibility and benefit estimates to optimize process for patients.
4. Stay current on federal and state regulations related to reimbursement and billing for durable medical equipment.
5. Collaborate with cross-functional teams, including revenue integrity, coding, compliance, and finance, to ensure alignment of billing practices with regulatory requirements and industry best practices.
6. Serve as a liaison between the revenue cycle department and internal stakeholders, external auditors, and third-party payers to resolve billing-related inquiries and disputes.
7. Ensure all patient billing inquiries and issues are addressed and resolved promptly and professionally.
8. Reviews collaboratively the denial management issues/resolutions related to operations using root cause analysis while ensuring training needs are met across the health system related to billing functions/findings.
9. Monitors regular billing audits for adjustments, denials, appeals, and customer account reconciliation projects and communicate findings to appropriate clinics and departments while assisting in resolutions.
10. Directs and provides guidance to managers to effectively allocate resources based on patient volume, space availability, budget constraints, and program priorities, goals, and objectives to achieve high standards within the billing departments, while building a strong culture around results and values.
11. Oversee billing backlogs and with the manager to develop a corrective action plan.
12. Assist with the clearinghouse vendor or payer to ensure reasons for delayed or rejected claims are addressed in a comprehensive manner.
13. Identifies opportunities and works toward cost reduction.
14. Works closely with the manager to minimize overtime expenses and maintain budget levels.
15. Lead and/or participate in all performance improvement projects for the revenue cycle as assigned and identified.
16. Develop, populate, distribute and monitor periodic performance metrics for all appropriate billing areas.
17. Maintains acceptable departmental billing performance as measured by performance tracking.
18. Monitor ongoing assessment, and creation of action plans to address all regulatory issues including CMS.
19. Interviews, hires, trains, evaluates and develops subordinate management staff in accordance with defined policies and objectives.
20. Provide feedback to management team regarding potential changes or enhancements to improve staff performance and ensure work quality has a positive impact on the revenue cycle.
21. Recognition and support for management team. Evaluates training needs and coordinates ongoing staff training.
22. Manages retention rates.
23. Oversee development of standard and ad-hoc reports.

Skill Set Requirement:

1. Comprehensive knowledge related to resolving National Correct Coding Initiative (NCCI), LCD, and MUE edits, along with professional, inpatient and outpatient hospital billing requirements.
2. Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding.
3. Strong organizational skills with the ability to work on multiple, complex projects with high quality results.
4. Thorough knowledge of Electronic Data Interchange (270/271, 276/277, 837, and 835 ANSI program transactions).
5. Excellent communication skills, both written and verbal that present clear and concise information to a diverse audience.
6. Knowledge of government/non-government payor practices including filing deadlines.
7. Appreciation of timeliness with resolving issues and determining priorities. Strong planning and delegation skills including ability to develop and cross-train staff.
8. Proficient with MS Office suite especially Excel and leveraging this tool to complete analyses.
9. Solid understanding of Epic and Epic business tools, to include use of Resolute, Prelude, Cadence and MyChart.
10. Thorough understanding of EDI standards for electronic claims submission.

Minimum Requirements

Required Education/Course(s)/Training:
Bachelor's Degree and/or 15+ years related work experience.
5 + years of applicable EPIC Revenue Cycle experience.
Minimum of eight to ten years of progressive experience in medical billing management required.

Required Certification/Registration:
CPC, CCS, RHIA, RHIT (must have at least one or being able to obtain within 8 to 12 months from date of hire).

Preferred Education:
Master's Degree and/or 15+ years related work experience.
EPIC Resolute certification.

Performance Expectations:

1. Successful achievement of the following:
2. Must be able to work independently and efficiently with little supervision.
3. Strong customer service and human relations abilities.
4. Ability to effect collaborative alliances and promote teamwork.
5. Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders.
6. Ability to use various computer applications is preferred including EPIC.
7. Ability to make good judgments in demanding situations.
8. Ability to react to frequent changes in duties and volume of work.
9. Ability to teach / transfer knowledge to supervisors/managers and team members.
10. Ability to recognize, evaluate, solve problems, and correct errors.
11. Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.
12. Ability to identify and implement process improvements to optimize revenue cycle performance.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.