Billing Manager

Support PPMW’s Revenue Cycle activities by assuming a senior role within the medical billing team. Oversee complex billing processes, conduct team training, and ensuring accurate and timely reimbursement for medical services. Oversee and assist in performing all billing and collection functions, including payment posting, A/R follow up, credit review, and grant billing. Provide feedback as appropriate, to improve affiliate performance and increase reimbursement. Active participant in meetings. Complete revenue cycle special projects as assigned.

• Handle high level billing tasks, including complex medical claims, appeals, and disputed charges.
• Review and verify claim information for accuracy, completeness, and adherence to payers for reimbursement.
• Utilize comprehensive understanding of claim denials to conduct appropriate claim follow-up on all open A/R to ensure prompt adjudication. 
• Ensure accuracy of billing data and compliance with local, state, and federal regulations, as well as payer -specific regulations.
• Assist in the development and implementation of policies, procedures, and workflows to improve efficiency.
• Work closely with coding, front office, clinical teams, and third-party vendors to resolve billing discrepancies and denials.
• Creation of claim projects with insurance companies and follow through on project to ensure resolution.
• Provide guidance, mentorship, and supervision of reimbursement specialists.
• Perform daily ERA, EOB, and patient payment posting.
• Reconcile payments posted in Epic to banking deposit logs.
• Submit invoices for participating grant programs.
• Submit daily electronic and paper claim files, and correct all claim and charge review edits, warnings and errors; run statement files; and download ERAs/EOBs as needed.
• Review and monitor clearinghouse claim errors and global payer rejections for possible system edits or payer updates.
• Prioritize workflow for reimbursement specialists to ensure the revenue cycle team is completing all necessary tasks.
• Daily review of billing work queues.
• Credit balance review and processing.
• Insurance benefit verification.
• Analyze payer denial trends and payer coding requirements to ensure payment of claims.
• Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed.
• Ensure the affiliate’s claim KPIs are satisfied.
• Participate in Revenue Cycle Team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes.
• Serve as an active agent on the billing line.
• Attend PPMW and PPFA training as well as other assigned training to improve knowledge base and claim efficiency.
• Follow up on denied claims with payers.
• Patient statement processing.
• Assistance with credentialing related inquiries and updates.
• Complete special projects as needed.
• Other responsibilities as assigned.

• Bachelors degree preferred, high school diploma or equivalent required
• Three or more years’ experience in medical billing and/or Accounts Receivable
• Epic experience preferred.
• Experience with patient billing and collections.
• Access to secure, reliable Internet and utilities.