Manager of Billing and Credentialing

Just a few of the Benefits enjoyed by PPIL employees…

-Company subsidized premiums on Medical, Dental, and Vision Insurance

-Up to 12 weeks Paid Parental Leave for eligible employees

-Generous Paid Time Off (PTO) and paid holidays

-Mission focused work

-401k with employer matching

-100% company-paid Life Insurance

-100% company-paid Short- and Long-Term Disability Coverage

-Robust Employee Assistance Program

-Professional Development awards and opportunities

-Flexible Spending Accounts

-Free Medical Services at PPIL

-Pet Insurance

The Manager of Billing and Credentialing is responsible for ensuring that all Health Center services are billed, collected, and reconciled, ensuring that all providers and locations are credentialed and re-credentialed, and supervising effective account receivables processes through accurate patient account maintenance, statement generation, and timely follow up. This position provides supervisory support across multiple teams that contributes to charge capturing, billing, collections and provider 

credentialing.

Essential Functions:

The Manager of Billing and Credentialing serves as the supervisor responsible for health center billing, Epic Workques, charge error resolution, and, patient customer service and follow up. This role also serves as the Health Center point-of-contact for provider credentialing and follow up. The Manager is charged with proactively ensuring patient account satisfaction and helping ensure that Planned Parenthood of Illinois’ (PPIL) practices remain in alignment with state, federal, and payer billing compliance.

1. Supervises the Contracts and Credentialing Team and ensures accuracy by applying consistent technical knowledge and follow up in daily workflow processes

2. Supervises the Billing/Revenue Integrity Team and ensures that all services that are received are reimbursed

3. Serves as Revenue Cycle Management (RCM) Liaison with PPIL Vendors to resolve Billing and Credentialing scopes through timely follow up

4. Ensures that all Health Center services are charged and that all Pre-Bill errors are resolved daily in the Epic Workques.

5. Ensures that accurate notes and complete follow up statuses are listed on patient accounts.

6. Ensures the maintenance and updating of the PPIL Fee schedules.

7. Ensures the maintenance and updating of the PPIL Charge master pricing and Coding by applying consistent technical knowledge and follow up

8. Ensures Team compliance with State, Federal and payer rules to prevent external audits and revenue loss

9. Ensures timely processing and resolution of Contact Center, Vendor and patient request.

10. Ensures up to date documentation is maintained in the patient accounting system to meet quality assurance and productivity standards.

11. Serves as the Internal Project Manager for Revenue Cycle Audits and Coding Training

12. Assist as an RCM Payer Relations “problem solver” on all denials/revenue loss related task and ensures follow up

13. Proactively Ensures Team PPFA Financial performance metrics are met by running EPIC BI report and monitoring Epic dashboards to ensure team guidance to prevent revenue loss

Other Functions:

1. Proactively stays up to date on Revenue Cycle standards, Coding and Credentialing through self- initiated professional development to ensure accountability in performance of the duties of the role.

2. Supports and Implements the Directives of the Director of Payer Relations and Revenue Cycle Management to ensure team compliance with Department Policies and Procedures.

3. Coordinates with Health Center staff to ensure that all clinical documents in the EHR are received and encounters are closed daily with reconciliation.

4. Maintain a professional and collaborative relationship with all teammates and vendors to resolve issues, increase knowledge of insurance requirements, and create standardized workflows

5. Facilitate training and onboarding of new teammates as well as ongoing training and education for established team members throughout the State of Illinois.

6. Through these activities demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers

7. Perform other duties as assigned.

Supervisor: Director of Payer Relations and Revenue Cycle Management

Status: Full-time. Exempt from the overtime provisions of the wage and salary regulations.

Physical Demands:

The physical demand characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, talk, read, see and hear. The employee is frequently required to use hands and fingers to type, handle, or feel and reach. The employee is regularly required to sit. The employee must occasionally lift and/or move up to 25 pounds.

Work Environment: 

• Associates Degree or equivalent combination of experience and education preferred.
• High School Diploma or GED required.
• Certification in Billing and or Coding is required.

• Strong knowledge of Self-Pay, Commercial, Medicaid/MCO Insurances Billing and Collections.
• Minimum of 5 years of relevant Healthcare Billing, Contracts Management and/or Charge master (CDM) experience required.
• Ability to demonstrate working knowledge of health care Billing and denials processes, including a thorough understanding of medical insurance carrier policies and procedures, State and Federal rules and regulations.
• Technology skills must include experience in the use of spreadsheet software (Excel) and the resolution of Billing Workques in the electronic records systems (EPIC) required.
• Project management and Revenue Cycle Charge master (CDM) database management skills desired.

• Excellent follow-through and attention to detail
• Ability to lead by example and inspire others to perform at their highest level
• Ability to proactively prioritize and attend to detail
• Excellent interpersonal relationship management skills
• Leads with Integrity and Accountability
• Strong communication, written and oral, and excellent organizational skills
• Ability to work under pressure and meet stringent deadlines, in a fast-paced environment with professionalism
• Commitment to maintaining confidential information

• Ability to think as well as act flexibly and creatively in a fast-paced environment.
• The position will be a hybrid model of remote work and on-site weekly. This position requires traveling to various Health Centers statewide periodically therefore a personal vehicle, a valid Illinois driver’s license, and auto insurance in accordance with agency liability standards is required.

• The Manager must demonstrate a commitment to the mission and operating goals of Planned Parenthood of Illinois.

Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We know that BIPOC and 

women or female identifying candidates are less likely to apply to jobs unless they meet every requirement. Please do not be deterred if your past experience doesn’t align perfectly with every qualification in the job posting. We encourage you to apply anyway! You may be exactly who we are looking for!