Position: Billing Team Lead

Department: Billing

Reports to: Practice Manager and Corporate Officer

Job Summary: This individual is responsible for assisting the Practice Administrator with creating and maintaining efficient billing and collection activity in the practice; maintaining the billing department database protocols and reference guides; maintaining current billing and coding files in the practice management system; and maintaining the corporate insurance contracts with regards to fee schedules, payment guidelines, authorizations and plan participation.

Education and Experience:

  • High School diploma and college degree in health care administration.
  • Previous healthcare work experience preferably in office setting
  • OCS certification in ophthalmology.

Essential Skills and Abilities:

  • Proficient in Excel, Word, and Outlook.
  • Effective communication with physicians, practice manager, employees, business contacts and the public through grammar, telephone and writing.

Personal Skills:Highly motivated, organized with attention to detail, able to handle multiple tasks, able to work under minimal supervision, trustworthy, team player, dedicated, accountable and appearance must be neat and professional.

Responsibilities:

  1. Contracts:
  • Credentialing:
  • Insurance contracts
  • Hospitals and Surgery Centers
  • New doctor
  • Doctor termination
  • Maintain CAQH database for providers (every 120 days)
  • Maintain provider ID’s
  • NPI
  • Maintain PECOS registration
  • Review new contracts for participation
  • Demographics(lives and area covered)
  • Fee schedule
  • Review content of contract
  • Review fee schedules with administrator for reimbursement levels annually
  • Review Provider Manuals for updates or changes on a quarterly basis.
  • Maintain insurance fee schedule database
  • Obtain current and new fee schedules for medical and vision plan
  • Understand reimbursement rules-codes payable and filing limit
  • Understand and maintain plan participation for contracted insurance companies:
  • HMO
  • PPO
  • Medicare Advantage
  • Medicare
  • Medicaid (according to Indiana Medicaid AKA IHCP-Indiana Health Coverage Program Cheat Sheet)
  • Maintain Insurance Provider Reference Database
  • Insurance Provider Manual
  • Insurance Consultation spreadsheet
  • Insurance Eye Code spreadsheet
  • Insurance Authorization spreadsheet
  • Insurance contract terms
  1. Billing
  • Understand the key components of the Medicare/Medicaid programs as it relates to Ophthalmology
  • Understand the key components of our most common commercial carriers as it relates to Ophthalmology
  • Complete Billing Department Monthly Analysis.
  • Run Office Production report to analyze doctor utilization of codes and record in production spreadsheet.
  • Maintain an efficient and profitable billing, coding and collection process as directed by our financial policy
  • Maintain Medical Coding Manual
  • Oversee billing department policies and procedures for efficiency and to maximize reimbursement
  • Set-up and maintain direct deposit accounts for insurance companies and MECA.
  • Maintain release of patient protocol and coordinate policies and procedures with Practice Administrator in order to make necessary write-offs and refunds
  • Identify low payer, slow payers and delinquent payers(billing specialists to report to supervisor)
  • Maintain PQRI protocol
  • Update measure annually or as needed in practice management system
  • Update routers, CPT database, and staff training
  • Maintain E-RX protocol
  • Run provider usage report monthly
  • Set up new user profiles in practice management system
  • Maintain computer edit issues for the billing department
  • Enter new CPT codes into the practice management system
  • Follow fee calculation protocol
  • Implement all correspondence as it relates to Ophthalmology for:
  • Medicare list serves and bulletins
  • Medicaid bulletins
  • VSP global news
  • Eyeball to Eyeball news letter
  • Maintain the ICD-9/10Coding Cheat Sheet in the practice management system to reflect annual changes in October
  • Update and maintain Botox payment allowance on a quarterly basis and make appropriate adjustments to the fee schedule and practice management system. Inform staff of updates on fees.
  • Update and maintain taxonomy codes twice a year (July 1st and Jan 1st).
  • Verify the necessity for pre-certifications for surgeries and post cataract glasses if needed.
  • Address billing issues with outside consulting firms or ophthalmic organizations
  • IAO help form
  • Maintain banking protocol to prevent theft
  • Maintain and understand the key components of the Medicare Advantage Plans as they relate to Ophthalmology
  • Address and correct any serious edit or denial issue we have with clearing houses when processing claims.
  • Handel all claim audits from insurance companies.
  • Maintain Payor ID Protocol with Front Desk Manager (Back-up)
  1. Human Resources
  • Update and monitor billing department job descriptions for billing supervisor and billing specialists
  • Conduct employee reviews on annual basis
  • Back-up to Billing Specialist due to illness, vacation, or problem resolution.
  • Train all new employees for HIPAA privacy and security
  1. HIPAA – Privacy and Security
  • Maintain HIPAA privacy and security manual
  • Understand when to execute a Business Associate Agreement (BAA) between business entities
  • Annual training  Eagle Associates: The Advisor – distribute to and collect from all employees
  • Keep current on rules and regulations – Read monthly Eagle Associates The Advisor publications
  • Run and monitor Control Scan for Transfirst system.
  • Online administrator for all websites for employees
  • Assign user IDs and passwords for insurance websites
  • Reset passwords if needed (employees cannot log on)
  • Inactivate/terminate passwords when no longer needed or employment ends
  • Maintain Medical Records protocol and electronic manual forms
  • Maintain and update any documents that have to do with billing or HIPAA posted in the display board in the main office lobby.
  1. Miscellaneous Office Operations:
  • Maintain protocol for deleting duplicate accounts and deleting transaction errors for billing department, front desk, and optical. Responsible for front desk and optical transactions
  • Backup supervisor in the absence of front desk supervisor as it pertains to billing and collections
  • Maintain forms and protocol for the use of office waivers:
  • ABN
  • DME
  • Medicare
  • Patient Liability Waiver
  • Medicaid
  • Financial Hardship Waiver
  • Maintain practice management billing protocol according to database instructions
  • Assess the need for practice management system updates from Compulink every six months: version updates
  • Maintaining diagnostics for the practice management system
  • Maintain and organize billing department database
  • Maintain and organize billing department interface forms on practice management system
  • Maintain and inform staff of the patient financial programs we offer.
  1. Billing Supplies
  • Order all billing supplies
  • Envelopes
  • Statements
  • Claims
  • Return envelopes
  • CPT & ICD-10 reference books
  • CMS 1500 forms
  • Ophthalmic Coding Series books and flashcards.
  1. Electronic Health Records (EHR)
  • Forward all meaningful use objectives to CMS to obtain incentive payment
  • Verify compliance under all meaningful reports from practice management system
  • Update EHR tables/custom tables in practice management system
  • Maintain process within practice management system for electronic router

Saved, admin drive, corporate data folder, human resources, job descriptions folder, business office, billing manager, 07/15/13, njm