Billing Manager

Position: Billing Manager

Report To: CFO/Chief FLSA

Status: Exempt

Department: Billing

SUMMARY

Responsible for the oversight of the Billing Department and ensuring that all claims (Indigent, Medi-Cal, Medicare, Other Health Care (OHC/Private Insurance) are submitted in a timely manner, reconciled and reported with accuracy and completeness of data for the purposes of management and compliance with the Los Angeles County Department of Mental Health contract (LACDMH). Ensures all billing activities comply with contracts, accreditation standards, licensing requirements, regulations and Hillview’s policies and procedures.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Ensures all claims are reviewed prior to submission, problems solved and submitted in a timely manner that protects claims from aging out. Ensures department performs monthly eligibility checks, submits claims to accurate payor and plan, works denials, voids and resubmits, unbilled claims, write- offs and Other Health Care (OHC) claiming and collection.
• Works collaboratively with Finance Department to report information needed for timely completion and submission of Cost Reports to LACDMH when required.
• Monitors and reports monthly on billed, denied and unbillable claims; write-offs: plan usage and reconciliation between Welligent system and LACDMH Electronic File Transfer (EFT) data.
• Collaborates with Quality Assurance, Medical Records and Finance team members to ensure communication on issues relating to billing and contract compliance. Collaborate with Quality Assurance Department regarding quality assurance issues reviewed by billing staff. Provides feedback on areas of strengths and areas of improvement and audit risk. Oversee organization of billing records for visits and audits.
• Research information for compliance with local, state, and federal regulations as needed and directed.
• Maintains documentation of billing activities; collaborates with other mental health or social service agencies.
• Maintains working knowledge of contracts, program standards and policies as developed by internal policy and procedures, DMH and other governing bodies; develops personal and professional knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the art practices, and participating in in-service programs.
• Recommends and assists in writing policies and procedures to facilitate communication and timely information flow to improve billing processes.
• Ensures cross-training of staff in billing systems. Ensure training guides are maintained for training new staff and cross-training purposes.
• Ensure all billing staff comply with the legal mandates of HIPAA for client confidentiality and release of information.
• Performs other duties as assigned.

SECONDARY DUTIES:

• Perform supervisory duties including recruitment, interviewing, and makes recommendations to executive management for hiring, training, developing and evaluating department staff; manages performance, conducts performance appraisals; takes disciplinary measures as needed.
• Develops and maintains effective working relationships with other Hillview departments to coordinate services and functions as needed.
• Incorporates Hillview philosophy and mission in all aspects of job performance.
• Attends and participates in department staff meetings, in-service programs, and other Hillview (i.e. Quality Improvement Committee, Welligent Project Meeting, Bi-monthly Billing Meeting, Welligent User Community meetings) and DMH (i.e. CIOB Reports and Revenue Management trainings, etc.) meetings as appropriate.
• Maintains confidentiality regarding clients, families and operations of Hillview.
• Exercises good judgment in the performance of duties and responsibilities.

REQUIREMENTS:

These specifications are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this job. Individual abilities may result in some deviation from these guidelines.

To perform effectively in this position, the Billing Manager must have:

• A complete working knowledge of submitting, evaluating and maintaining Medicare, OHC and Medi-Cal billing in behavioral health/human services organizations.
• Prior experience with DMH billing standards.
• Functional knowledge of the Tableau software.
• Basic supervisory skills to manage a small staff.
• Demonstrated leadership skills to promote and develop billing expectations throughout a large organization.
• Ability to be detail-oriented, follow-up on concerns, and understand systems which help ensure quality of service, contract compliance and accurate recordkeeping.
• Exhibit effective communication skills both oral and written, including public speaking.
• Ability to be flexible and work in a changing environment.
• Computer skills are sufficient to meet production demands of the job including Microsoft Office, including Tableau and Welligent software.
• Sensitivity to the different cultures represented among the clients, members, partners and staff.
• Knowledge of Hillview’s emergency procedures.
• Ability to work effectively as part of a team.
• Effective problem-solving skills, and management skills.

QUALIFICATIONS:

Ability to perform the job safely, without endangering the health or safety of him/herself or others.

A minimum of three years computer experience with Microsoft Office, including Tableau and Welligent software, or another electronic health record system software.

EDUCATION and/or EXPERIENCE:

Bachelor’s degree in a related area or education in progress. A minimum of five years of experience working in a billing department in a behavioral health setting. Certified in Medical Billing and Coding.

EQUIPMENT USED:

PC computer, fax, telephone, calculator and other office equipment, as appropriate. Uses a vehicle to drive to other locations.

LANGUAGE SKILLS:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

MATHEMATICAL SKILLS:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

REASONING ABILITY:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is frequently required to use hands to finger, handle, or feel; reach with hands and arms; talk and hear; and sit. The employee is occasionally required to stand and walk. Specific vision ability required by this job includes close vision and ability to adjust focus. Required to drive vehicle to various locations.

WORKING ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

While performing the duties of this job, the employee works in an environment where the noise level is usually moderate. Employee will periodically visit other locations and be exposed to outdoor weather conditions.

OTHER REQUIREMENTS:

Employee must have a current California Driver’s License with a clear and insurable driving record and proof of insurance.

Overview
Group meeting at HillviewServing more than 2,000 clients, Hillview Mental Health Center empowers individuals affected by mental illness to flourish and live productive, fulfilling lives. Our staff of psychiatrists, nurses, clinicians, recreational therapists and case managers work collaboratively to provide individually tailored services for our clients. These services can include medication evaluation and treatment, individual or group therapy, case management, substance abuse treatment and crisis management.

In all of our interactions, we treat our clients with dignity and compassion, helping them to identify their needs and goals and maximize their strengths.

We understand that our clients have practical needs that affect their ability to recover and thrive. We work closely with government and nonprofit agencies to help our clients obtain housing, transportation, schooling, employment and other supportive services. Hillview Village, our permanent housing complex, provides a welcoming home to 85 low income, chronically homeless clients.

Mental illness impacts all facets of life. Without treatment, individuals may cope by engaging in unsafe and unhealthy behaviors such as substance abuse and crime. We have expertise in helping clients who suffer from drug or alcohol abuse, as well as in assisting those newly released from jail or prison to successfully re-enter society.