PROFESSIONAL BILLING MANAGER
Area: PATIENT FINANCIAL SVCS
POSITION#: TBD
Hrs/Week: 40
Shift: 8:00 AM – 5:00 PM / M-F
Grade: 15
DESCRIPTION: The Professional Billing Manager will be responsible for all activities related to the professional billing accounts receivable. Primary role is to protect the accounts receivable assets of Grady Health System professional billing by oversight for quality assurance, billing and follow-up, professional billing company, payment posting, denials, refunds, and accounts receivable analysis. The incumbent develops and monitors professional services billing activities to ensure all accounts have complete and accurate data to provide for timely billing and optimal reimbursement for services. Additionally, this incumbent should posses and affect expertise in all areas of governmental and third-party reimbursement for inpatient and outpatient hospital services.
EDUCATION / REQUIREMENTS: Baccalaureate degree in business administration, finance, accounting, healthcare administration or a related field or related or equivalent education, training and/or experience required. Minimum of three (3) years to five (5) years of experience in medical or hospital professional charging and billing functions, one (1) of which included supervisory or administrative experience. Must have knowledge of correct coding principles of CPT/HCPCS and modifier selection, as well as, UB04 revenue codes and 1500 billing requirements. Experience with medical record to bill reviews for charge capturing accuracy. Thorough knowledge of CMS and state coverage and payment methodologies. Working knowledge of professional billing company operations; ability to plan, implement and evaluate systems and procedures; ability to manage multiple priorities; ability to communicate effectively; ability to establish and maintain working relationships with a wide range of staff including outside vendors; skilled in the use of Microsoft applications; excellent analytical and critical thinking skills; initiative; tact; physically capable of performing the essential functions of the positions with or without reasonable accommodation. Completion of reports for documentation of issues in Word and Excel spreadsheet formats. Skills need to include knowledge of medical billing operations, hospital department charge capturing, revenue cycle services and CMS regulations. Physical requirements are minimal with occasional standing or walking; minimal lifting or other physical exertion. Requires close and distance vision; the ability to talk, hear and manual dexterity. The work environment involves occasional exposure to blood borne pathogens and infectious diseases. The noise level is moderate.