Ambulatory Surgical Center Billing Manager

Ambulatory Surgical Center Billing Manager

Oversees the day-to-day billing and collection operations for the Ambulatory Surgery Center facilities. Responsible for maximizing revenue through accurate charge capture, claims submission, timely remittance posting, post-procedure patient collections and denial management. Ensures compliance with company standards and government regulations. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

Key leader in managing mid- and back-end revenue cycle functions including procedure and coding capture, claims processing and submission to clearinghouses and insurance companies, payment posting and reconciliation, patient collections, claim denial resolution and reporting activities of the department. Assists VP with implementation of revenue cycle, customer service, human resource, and financial goals and objectives consistent with the organization's strategic plan and goals. Develops, implements, monitors, and periodically reviews and adjusts as necessary CBO specific policies, procedures, and programs for managing billing and collections under third party payer contracts. Monitors adherence to those policies, procedures and workflows and to system-wide policies / standardizations.

Manages the billing and collections team. In collaboration with Human Resource department, responsibilities include performance evaluations, disciplinary actions, staff training and development, promoting teamwork, and fostering a positive work environment. Monitors teams' staffing mix, workload and allocation of resources for efficiency and to meet department objectives and benchmarks, recommends changes as appropriate. Trends and analyzes accounts receivable, payer claim denials, remittances and rejections to identify opportunities to prevent denials, improve collection rates and implement revenue enhancement opportunities. Prepares and analyzes billing reports, including accounts receivable aging, denial rates, and collection statistics.

Meets regularly with clinical and administrative teams on revenue cycle performance. Addresses patient service complaints to ensure customer satisfaction. Works with Coding Quality, Finance, contracting and health plan provider representatives, to ensure revenue cycle quality measures and goals are met. Works closely with Revenue Integrity Unit analysts to maximize PM system performance and support of team needs. Participates in testing and implementation of new applications, monthly release and upgrades as needed. Stays abreast of federal and state insurance laws, rules and regulations and ensures departmental compliance. Acquires a strong working knowledge of Epic PM related to its billing and reimbursement processes. Routinely interacts with and supports staff. Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct. Regular and dependable attendance. Follows the core competencies set forth by the Company, which are available for review on CMSweb.

Attends ongoing organizational training to maintain compliance requirements and to improve leadership and supervisory skills. Performs other duties as assigned.

Education and Experience Required : High school diploma or GED. Bachelor's degree in healthcare administration, business, or a related field or relevant work experience may be substituted for bachelor's degree on a year-to-year basis. Five (5) or more years of increasingly responsible billing experience, to include supervision of staff for an ASC or similar health system or hospital setting. Proven proficiency in financial management, which includes comprehensive understanding of insurance plans as they relate to physician practice.

Knowledge, Skills and Abilities Detailed knowledge of ASC-specific procedural and diagnostic coding, payor and reimbursement policies. Familiarity with laws and regulations related to ASC healthcare delivery compliance. Knowledge of and experience with Medicare, Medicaid and commercial insurance plan billing policies, practices, and resources, and applicable collections-related law. Knowledge of human resource fundamentals and underlying laws, i.e., FLSA, ADA, FMLA, etc. Proficient computer skills and knowledge of Microsoft Office programs. Excellent interpersonal & problem-solving skills. Ability to analyze and interpret financial data / reports. Ability to engage others, listen and adapt response to meet others' needs. Ability to align own actions with those of other team members committed to common goals. Excellent computer and keyboarding skills, including familiarity with Windows. Excellent verbal and written communication skills. Ability to manage competing priorities. Ability to perform job duties in a professional manner at all times. Ability to understand, recall, and communicate, factual information. Ability to understand, recall, and apply oral and / or written instructions or other information. Ability to organize thoughts and ideas into understandable terminology. Ability to apply common sense in performing job.