Director of Billing

Overview

We are looking for a dynamic leader to join United Health Centers as our Director of Billing at our corporate office in Fresno, CA. This position is an exempt position that is fully in-person and Monday-Friday. 

This position is responsible for overseeing the employees and responsibilities of the Billing Department. The individual will design, implement, and enforce policies and procedures, as well as create efficient and effective billing processes across multiple payors. This position requires a strong leader with the ability to prioritize, plan, and direct the department's performance to meet the strategic goals of the United Health Centers of the San Joaquin Valley. The Billing Director is responsible for revenue maximization for all United Health Centers’ receivables. The Billing Director identifies, investigates, and resolves compliance issues relating to coding, billing, documentation, and reimbursement activities. Serves as a subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations. Researches, leads, and directs the implementation of compliance with new billing rules, regulations, laws, and payor contractual requirements. This position reports to the Chief Financial Officer (CFO).

Responsibilities

Summary of Responsibilities:

• Achieve Billing operational objectives in billing, collections, and staffing
• Ensure billing and collection record keeping and reporting systems are maintained
• Review claims and denials to ensure that they are prepared properly and follow-up when necessary.
• Provide customer service and support to Medical Billing staff, patients and their families, medical and dental staff, clinical support staff, and all public and professional contacts associated with patient accounting and payment recovery.
• Manage compliance of all federal, State, and private insurance carrier requirements.
• Fosters an environment that promotes teamwork and positive communications within the service area and department.
• Works to establish policies and procedures to assist UHC in maximizing contract provisions with health plans.
• Effectively communicates changes regarding contracted health plans for claims processing, data management and information systems, financial management, eligibility verification, specialty panel access, patient tracking provider relations, patient satisfaction and health education to staff.
• Monitors effectiveness of collection efforts and maintains payment processing is current within the established time frame specified in the department policy.
• Ensures outstanding customer services are delivered consistently and within department and organization guidelines.
• Works to foster an environment that promotes UHC's Quality Improvement Program.

Establishment and Implementation of Managed Care Two-Plan Model for United Health Centers.

• Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable, follow-up, and reimbursement management.
• Serves as the practice expert and go to person for all coding and billing processes.
• Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings.
• Prepares and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts with the Chief Financial Officer.
• Collects and compiles accurate statistical reports for general reporting or dashboard reporting.
• Audits current procedures to monitor and improve efficiency of billing and collections operations.
• Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and follow Federal, State, and payer regulations, guidelines, and requirements.
• Participates in the development and implementation of operating policies and procedures.
• Reviews and interprets operational data to assess need for procedural revisions and enhancements.
• Participates in the design and implementation of specific systems, including practice management system to enhance revenue and operating efficiency.
• Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures.
• Keeps up to date with carrier rule changes and distribute the information within the practice.
• Understands and remains updated with current coding and billing regulations and compliance requirements.
• Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
• Maintains library of information/tools related to documentation guidelines and coding.
• Works with the Billing Manager to direct billing office personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
• Works with Billing Manager to provide and oversee or coordinates the provision of training for new and existing billing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
• Performs other miscellaneous job-related duties as assigned.
• Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
• Plays a key role in the development and maintenance of the billing practice management system/s.
• Works with Health Center Manager's and/or Health Center Assistant Manager's on billing and coding patient or provider issues or concerns.
• Works closely with the Billing Department and other members of the clinic management team to implement internal procedures that support the billing model for the specific county in which the health center resides.
• Supports compliance with the plans by preparing written policies and procedures to ensure that the health center meets with health plan requirements and expectations.
• Creates and maintains sound working relationships with the provider staff, health plans and other public and private agencies in order to develop and implement managed care policies and procedures.
• Works to communicate health plans specifics regarding claims processing, data management and information systems, financial management, eligibility verification, specialty panel access, patient tracking provider relations, patient satisfaction and health education to staff to ensure compliance.
• Works to establish procedures to assist the health center in maximizing contract provisions with health plans and programs to ensure that they are implemented successfully, and that maximum reimbursement is achieved.
• Responsible for representing the interests of the health center and its patients to the health plans and agencies.
• Supports UHC's financial focus by maintaining an active awareness of opportunities that can help strengthen the health center.
• Establishes and maintains computer linkages between the health center and the plans to ensure patient eligibility, verification of authorizations issued, and related information items. .
• Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable, follow-up, and reimbursement management.
• Audits current procedures to monitor and improve efficiency of billing and collections operations.

General Corporate Expectations.

• Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.Other work-related duties as assigned by supervisor. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.Supports the overall needs of the health center by working flexible or extended hours when necessary.Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.Supports their own staff development by completing the required hours of continuing education each year.Maintains confidentiality and respect for information regarding patients and other team members; abides by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.Displays a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the health centers.Contributes to the team by promoting positive staff interaction, maintains open communication with other programs/departments.

Qualifications

EDUCATION AND LICENSE/CERTIFICATION:

• Bachelor's Degree in Business or Health Administration or related field.

LICENSE/CERTIFICATION:

• Possess a valid CA Driver's License.

PRIOR EXPERIENCE:

• Minimum of five (5) years Medical Insurance/Healthcare Billing and Collections experience in a healthcare setting, preferably a FQHC, with a deep understanding of medical billing rules and regulations.
• Two (2) years supervisory or management experience preferred.
• A combination of education and experience will be considered.

SKILLS:

• Comfortable understanding of code sets (e.g., ICD-9, CPT, CDT, etc).
• Understanding and experience in contract negotiations.
• Clear working knowledge of State and Federal regulations regarding managed care and Knox-Keene Health Plan Services Act.
• Communication skills which include ability to draft corporate documents, procedural guides, technical writing, and agreement/MOU writing.
• Bilingual (English/Spanish).
• Able to quickly build and maintain a rapport with patients and providers of differing backgrounds; team player.
• Meeting facilitation and curriculum development skills that include understanding of adult learning and general training techniques.
• Demonstrated effective problem-solving skills; sound judgement.
• Effective leadership/supervisory skills.
• Expert at modern office practices and procedures.
• Intermediate to advanced computer skills including strong with MS Office (Word/Excel/PowerPoint/Access).
• Project management skills and experience.
• Able to handle multiple tasks simultaneously.

PHYSICAL REQUIREMENTS:

• Must be able to lift up to 20 pounds and push up to 50 pounds (on wheels).
• Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to patients and staff.
• Must be able to read memos, computer screens, personnel forms and clinical administrative documents.
• Must have high manual dexterity.
• Must be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn.

The salary range that UHC reasonably expect to pay for the position upon hire starts at $107,899.69. Our salaries are dependent on knowledge, skills, and experience. 

In addition, our comprehensive benefits package for regular status employees includes:

• Medical, Dental, and Vision insurance with low premium cost
• Paid time off and paid holidays
• 401k plan with matching contribution
• Educational Assistance
• Employee discounts and more!