Our mission at Progenity is simple: to help healthcare providers and patients prepare for life. We provide the most advanced molecular technology and the highest levels of service to guide patient care at critical life stages. We continually seek people with the motivation and skills to advance our mission.
The Manager of Billing Operations works to provide direction and leadership to the Pre-Billing and Financial Services team. This position involves direct supervision and training of the staff, allocation of the daily workload and motivating employees to achieve peak productivity. This includes effectively monitoring and reporting on billing metrics an strategic revenue opportunities, making strategic changes and improvements as necessary and establishing key relationships with various regional and national payers, including Federal, State, Third Party (HMO,PPO, IPA, TPA Indemnity). This position will be responsible for creating structure around the Prior Authorization process, monitoring coding to ensure clean claims are being billed out, and overseeing the Financial Services team.
RESPONSIBILITIES
- Provides oversight and support for the Pre-Billing and Financial Services team.
- Prepares periodic reports on team performance and establish production goals and quality standards.
- Assists with technology implementation, including project planning and management.
- Confirms appropriate authorization and documentation has been secured prior to billing, and ensures claims are billed accurately and timely.
- Maintains strong understanding of payor related changes across all states/markets.
- Assists in reviewing billing and documentation requirements to ensure claims are compliant.
- Maintains a good working knowledge of authorization requirements for all payors and state/federal regulatory guidelines for coverage and authorization of outpatient services.
- Cultivates and maintains intradepartmental and professional relationships.
- Conducts bi-weekly team meeting and weekly One x Ones with staff and provide feedback on their progress to goals.
- Utilizes systems to research, analyze, and report on ways to maximize revenue and ensures continual revenue cycle process improvement.
- Designs and implements policies, protocols and systems to improve team productivity.
- Monitors billable revenues to identify and explain significant variances.
- Works collaboratively with all levels of personnel and management on revenue cycle performance to meet strategic goals and review all guidelines, policies, and procedures through use of data analysis.
- Ensures trends that identify billing errors are addressed with the biller and/or the team as appropriate.
- Communicates with vendors to ensure billing work flows are moving adequately.
- Provides transparency to upper management with reporting tools for metrics in the Billing Department.
- Assists with hiring and training new employees within the Pre-Billing and Financial Services teams.
- Manages revenue enhancing projects as directed by Billing and Reimbursement leadership.
This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities, as deemed necessary.
REQUIREMENTS
- Bachelors degree from accredited college/university or equivalent experience in healthcare.
- Minimum 4 years of experience in a Management role, including hiring, training and mentoring, and performance management.
- Must be familiar with a variety of the field’s concepts, practices, and procedures.
- Must be proficient in Microsoft Outlook, Excel, Word, the Inter and Intranet, and other programs/software as necessary.
- Working knowledge and hands-on experience with medical billing and reimbursement strategies.
- Experience with the Quadax billing system a plus.
- Working knowledge of appropriate coding systems; CPT, ICD-9/ ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with associated codes.
- Working knowledge of appropriate coding systems; CPT, ICD-9/ ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with associated codes.
- Excellent verbal and written communication skills including ability to provide training to other departments as well as staff and leadership to new employees.
- Problem solving skills, using good judgment, attention to detail, and follow-through are a must.
- Ability to prioritize work, multi-task, and manage time.
- Ability to assist other employees with prioritization.