Mgr, Billing

Job Description
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 Manager is primarily responsible for assuring that clear lines of authority, communications and delineation of all hospital and physician billing duties have been established and assigned. The Manager will oversee all applicable hospital and physician billing job functions as stated in organizational and departmental policies and procedures. The Manager is responsible for researching, analyzing, resolving and trending billing rejections.
The Manager will provide educational programs related to billing resolution techniques along with the responsibility of keeping informed of new changes in federal, state and third-party billing regulations. Resolving ways to work within any new regulation with the approval of the Director as well as coordinating any testing or move to production efforts as it applies to hospital and physician billing functions and workflows. Review all billing/payer edits and reason/remark codes to ensure there are continual updates. The Manager will also work closely with the Director to maintain appropriate files, reports and other statistical data as required and provide results of all special projects along with recommendations for additional revenue opportunities. Coordinates re-bills and adjustments of accounts based on hospital and physician audit results.
The Manager will work closely with Patient Access, Managed Care Contracting, Process Improvement, Insurance Follow-up, Denial Management, Medical Records, hospital and physician staff. The Manager will coordinate activities with other departments as approved by the Director and is expected to demonstrate, through plans and actions, that there is a consistent standard of excellence.
Responsibilities
Essential Accountabilities:
Financial Management: Supports the financial management for area.
Performance Criteria:
1. Responsible for billing and overseeing and coordinating the processing for Medical Necessity and Correct Coding Initiative requirements.
2. Identify, research, mitigate and works with Director to resolve issues with revenue cycle billing related systems.
3. Manages billing backlogs and develop corrective action plans.
4. Works directly with clearinghouse vendor or payer to ensure reasons for delayed or rejected claims are addressed in a comprehensive manner.
5. Evaluate trends and adjust billing operations as approved.
6. Identifies opportunities and works toward cost reduction.
7. Works closely with supervisors to minimize overtime expenses and maintain budget levels.
8. Reports rejection trends and conducts root cause analysis to prevent future rejections from occurring in relation to billing edits.
9. Demonstrate, through plans and actions, that there is a consistent standard of excellence to which all departmental work is expected to conform.
10. Lead and/or participate in all performance improvement projects for the revenue cycle as assigned and identified.
11. Ensure all billing/payer edits are continually updated
12. Achieves department quality standards.
13. Meets targeted level of satisfaction as measured by the appropriate satisfaction surveys and feedback.
14. Oversees daily operations to ensure processes are efficient and effective in meeting department goals and objectives.
15. Monitoring adherence to process and communication upon recognition of potential billing financial or operational issues identified within the revenue cycle.
16. Manages operations by ensuring compliance with all appropriate internal policies and procedures and external regulatory and accrediting agencies.
17. Develop, populate, distribute and monitor periodic performance metrics for all appropriate billing areas.
18. Maintains acceptable departmental billing performance as measured by performance tracking.
19. Responsible for the ongoing assessment, monitoring and creation of action plans to address all regulatory issues including CMS.
20. Serves as functional areas main contact with internal and external auditors.
21. Coordinate and distribute workload to staff, provide training to staff, assist with employee orientation and formulate minutes of meetings and ongoing process and distribute to staff.
22. Interviews, hires, trains, evaluates and develops subordinate management staff in accordance with defined policies and objectives.
23. Incorporate the organizations values into all staff development practices and all departmentally directed activities.
24. 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.
25. Recognition and support for management team. Evaluates training needs and coordinates ongoing staff training.
26. Develops and recognizes staff through coaching, planning, training, appraising, and counseling.
27. Manages retention rates.
28. Performs all other duties as needed or directed to meet the needs of the department as required by management.
Standards of Performance
A.Workplace Expectations
1. Professional Appearance: Our appearance represents ECU Health. Therefore, our grooming and dress will reflect our respect for our customers. While on duty, we will first consider our customers expectations in how we present ourselves. Our manner and expression will convey our concern for and willingness to serve our customers.
2. Safety Awareness: Safety must be the responsibility of all ECU Health employees to ensure an accident-free environment. Accidents are the result of actions and attitudes that you can help to change.
3. Corporate Compliance: Integrity is doing the right thing by being honest in our dealings with one another, our patients and our business contacts. Integrity is doing the right thing by maintaining the security and confidentiality of patient information.
B.Behavioral Standards
1. Etiquette in the Workplace: Workplace etiquette can create a favorable impression on our patients, visitors, and co-workers. Good manners contribute to patient satisfaction.
2. Communication: The goal of communication is understanding. We must be committed to listening attentively to our customers in order to fully understand their needs. Close attention should be given to both verbal and non-verbal messages. Our messages to customers should be delivered with courtesy, respect, clarity, and care. We must avoid confusing our customers and speak in terms they can easily understand.
3. Customer Relations: At ECU Health we believe that we are here to serve our customers our customers are patients, family, co-workers, physicians, and vendors. Our customer' most basic expectation is to be treated with courtesy and respect. We are committed to providing the highest quality of service and meeting customers needs with utmost care and courtesy.
4. Working Relationships: As ECU Health employees, we are linked to one another by a common purpose: serving our patients and our community. Our co-workers, therefore, are our teammates. They deserve our respect. Without their contributions, none of us could perform our jobs. Just as we rely on our fellow employees, they rely upon us. Each of us has obligations to our co-workers.
5. Sense of Ownership: Every ECU Health employee should feel a sense of ownership toward his or her job. By this we mean taking pride in what we do, feeling responsible for the outcomes of our efforts, and recognizing our work as a reflection of ourselves. Take pride in this organization as if you owned it.
Minimum Requirements
Required Education: Associate Degree and/or 5 to 10 years related work experience
Preferred Education: Bachelor's Degree and/or 10+ years related work experience
Required License:CPC, CCS, RHIA, RHIT (must have at least one or being able to obtain within 8 to 12 months from date of hire)
Required Experience: Five or more years of leadership experience in a directly related role. National Correct Coding Initiative edits, LCD, MUE and physician/inpatient and outpatient hospital billing requirements. Thorough knowledge of Electronic Data Interchange (270/271, 276/277, 837, and 835 ANSI program transactions)
Preferred Experience: 10+ years of experience in hospital and physician billing. Database software, Strong knowledge of documentation requirements and insurance carriers billing policies. Computer skills including word processing, spreadsheets, Internet and Intranet software, e-mail.
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.