Responsible for department operations including billing, collections, insurance follow up and denial management. Ensures that billing and collection functions are performed in accordance with all governmental regulations and is compliant with specific third party payer requirements. Establishes processes and applies technology to facilitate efficient, timely, and accurate billing and collection of client accounts.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Develops written office procedures and manuals related to billing and revenue cycles, and distributes and implements same, with approval of AVP of Business Operations.
Maintains accurate adherence to coding schemes and billing rules required by third party payers.
Establishes operational goals and priorities directed at optimizing accuracy, efficiency, and productivity.
Supervision, training, and motivation of Client Financial Services staff.
Analyzes and reports on procedures and processes related to revenue cycle. Prepares action plans for improvement as necessary.
Oversees collection of commercial, Medicare, Medicaid and self pay accounts. Assists with problem accounts.
Develop, implement and manage quality control, follow-up, reconciliation, and audit procedures to ensure accuracy in coding, data entry, cash receivables, and billing.
Monitors and analyzes A/R balances by payer and identifies barriers to timely payments.
Ensures proper follow-up on source and reason for third party billing rejections and generation of follow-up claims.
Works collaboratively with other staff to develop best practices.
Oversees claim submission process including, but not limited to collecting, posting, and managing account payments.
Authorizes client payment plans as appropriate.
Identifies and resolves patient billing complaints.
Handles collection on unpaid accounts and determines when account should be deemed uncollectible for approval by the AVP Business Operations and/or CFO.
Maintains/updates Agency fee schedules and client fee agreements.
Develops and maintains working relationships with all third party payers and acts as a principal liaison.
Completes, submits applications, and sets up billing capabilities for third party contracts as necessary.
Participates in regular management meetings and problem solving work groups as needed.
Performs other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill and or ability required. Reasonable accommodations may be made to enable an individual with a disability to perform the essential duties and responsibilities.
EDUCATION AND EXPERIENCE
High School Diploma required.
Bachelor’s Degree in Finance, Business, or related field preferred.
At least 5 years of Revenue Cycle Management (“RCM”) experience is required, preferably in a behavioral health setting.
Past work experience must include direct staff supervision.
Excellent customer service and verbal/written communication skills.
Superior attention to detail and ability to meet deadlines.
Ability to multi-task and prioritize.
Ability to effectively diagnose problems, then develop and implement remediation plans.
Ability to effectively present information to management.
Extensive knowledge of third party billing requirements and procedures including Medicare, Medicaid, Managed Medicaid, and other and commercial insurance payers.
Sound knowledge of HCPCS, CPT, and ICD-10 coding.
Facility with computers, including MS Office, spreadsheet applications.
Pillars is the largest nonprofit provider of mental health and social services in the western and southwestern suburbs of Chicago. We aspire to build healthier communities by making connections and changing lives. In other words, our goal is to connect people to the resources they need to help them stay healthy or get back on their feet.
Pillars’ main lines of service are Mental Health, Addi...ctions, Domestic and Sexual Violence, Child and Family Services, and Community Housing. We have more than 30 programs within those lines of service. Our eight office locations span the western and southwestern suburbs of Chicago, including La Grange Park, Berwyn, Hickory Hills, Summit, and Western Springs. Several of our services are also provided in community settings including homes, schools, police stations, courthouses, and emergency rooms. Many of our services are bilingual, and many of our clients are low-income and/or use Medicaid.
Learn more at www.pillarscommunity.org
Pillars is an Equal Opportunity Employer. We consider applicants for all positions without regard to race, religion, creed, color, national origin, gender, age, marital or veteran status, sexual orientation, disability or any other legally protected status.