North Shore Pediatric Therapy

  • Billing and Insurance Manager

    Job Locations US-IL-Des Plaines
    Category
    Management
  • Overview

    The Director of Billing and Insurance’s role is to oversee the billing department staff and processes to ensure accurate and effective revenue cycle management.  This involves understanding the billing cycle from beginning to end, as well as assessing and maintaining a healthy revenue cycle on a daily, monthly and quarterly basis.

    Responsibilities

    • Oversee departmental roles and outsourced billing company
      • Analyze productivity/areas of strengths/weaknesses
      • Assure accurate SOP’s are in place and updated with any new process changes
      • Creating all SOP’s for new CR processes
      • Create productivity standards for direct reports
    • Staying up to date on billing/coding procedures and updates
      • Attending conferences
      • Research based on current reimbursement
    • Contracting with other insurance carriers
      • Assessing needs in areas for other insurance carriers and pursuing contracts with them
      • Staying on top of contracts to assure tight deadlines are being met
      • Strong contract negotiation skills
      • Assessing fee schedules to make strategic moves in regards to contracting
      • Prep B&I department with all resources for new carriers in relation to billing and guidelines
    • Credentialing
      • Analyzing areas that require strengthening
      • Identifying ways to maintain/improve CAQH process
      • Credentialing all new hires with all insurance carriers in a timely manner
      • Following up with credentialing status’ per carrier’s timeline
      • Billing out claims for these providers once approval is received
    • New employee set up
      • Setting up employees within all systems
      • Central Reach
      • Demographics
      • Scheduling
      • Payroll
      • Billing
      • Completing carrier applications (credentialing)
      • Follow up once sent to clinicians
    • Accounts Receivables
      • Analyzing A/R daily to assure accounts are being actively worked on
      • Identify areas/carriers that need extra efforts
      • Assure accuracy of fee schedules vs. received
      • Patient Collections
      • Assuring standarized processes are in place with Central Reach 
    • Organizing project teams for areas that need immediate attention
      • Create measures for success
      • Assure deadlines are being met and reported against
    • Monthly Close
    • Work closely with finance department to assure timely closing of month
    • Provide CFO month-end reports for all charges, payments, adjustments received for prior month
    • Assure cut-off times are accurate for reporting
    • Provide CFO with monthly Accounts Receivable totals
    • Other duties assigned from time to time

    Qualifications

    • Bachelor's degree in accounting/finance/business management preferred, high school diploma or GED required
    • 3+ years of recent medical billing experience in a management role
    • Excellent oral, listening, written communication and self-awareness skills
    • Self-motivated with the willingness and accountability to exceed client expectations
    • Willing to roll up your sleeves and perform detailed, hands-on work
    • Proven ability to perform strategic planning and priority setting for a billing department
    • Proven track record for analyzing/improving process efficiencies and solving problems
    • Strong leadership skills with an ability to motivate direct reports
    • Ability to work in a fast-paced environment with changing circumstances while maintaining a positive attitude
    • Excellent organization, planning, prioritization and time-management skills
    • Excellent interpersonal skills and have experience facilitating positive interactions
    • Must respond quickly to email and telephone calls
    • Must be computer proficient, especially with Microsoft Office
    • Ability to travel locally

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