Billing Resolution Advocate

The Billing and Posting Resolution Advocateis responsible for overseeing claims production, billing, follow-up, collections, and compliance with third party payer regulations. This position is responsible fordaily oversight and management of process-based revenue cycle functions, including ongoing improvement to key revenue cycle indicators. These indicators include but are not limited to: A/R days, cash collection goals and posting, denials, underpayment and contract management activities related to patient account management. The Billing Manager should have comprehensive knowledge of revenue cycle operations.

Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include:

• Possess complete understanding of the billing/collection process to resolve complex, outstanding claims.

• Ensures accounts are billed accurately and timely by providing proactive oversight and direction for billing and collections.

• Provides operational oversight for the Billing Coordinator, mentoring them in their responsibilities

• Maintains current knowledge of hospital billing systems and government payer systems, including applicable federal/state laws and regulations, as well as all aspects of third-party reimbursement policies and practices

• Demonstrates ability to manage, train and motivate employees, as well as a professional attitude in relating to executive management, professionals and third-party insurance carriers.

• Organizes and leads efforts to maximize operational efficiency and optimize reimbursement, as well as monitors denials and provides education and reporting to the areas regarding the effect of denials from their areas.

• Reviews all statistical reports to monitor trends, determine operational deficiencies and implement corrective action plans as necessary

• Pro-active communication/escalation of potential claims/unbilled accounts/issues to the Director

• Exhibits excellent leadership and self-direction, good judgement in handling difficult situations and good organizational, time management, interpersonal and conflict resolution skills.

• Assures that confidentiality of patient information is maintained without exception

• Attends all required meetings and activities, maintaining a professional affiliation to stay abreast of current trends and changes in legislation and industry best practices.

• Liaise with facility management and operates as the lead point of contact

• Maintain employee time and attendance and scheduling demands

• Responsible for accuracy of customer invoices, and creating the invoices monthly

• Understanding the contract terms and insuring we stay within those terms

• Performs all functions from the Management Expectations List

• Performs all other duties assigned

Minimum Requirements:

Education/Experience/Certification Requirements

• High school graduate or GED equivalent

• 3 years previous hospital billing experience

• Working knowledge of insurance regulations, procedure and diagnosis coding and automated insurance billing

• Excellent communication (written and oral) and interpersonal skills

• Excellent critical thinking, organizational and time management skills with a strong attention to detail, accuracy and follow through

• Must be able to work through issues to resolution

Preferred Qualifications:

• Associates or Bachelor’s Degree

• 2 years Medicare hospital billing experience

Originally posted on Himalayas