Billing Lead

Conifer Health Solutions•Modesto, CA

About The Position

Supports the billing functions for assigned clinicians and works with the RCM vendor partner on daily revenue specific job functions, budget targets and all other responsibilities. Adheres to and supports the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources. Adheres to the Tenet HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement. Demonstrates support for the Tenet Corporate Compliance Program by being knowledgeable of compliance responsibilities as expressed in the Code of Conduct; adhering to federal and state laws, rules, regulations, and corporate policies and procedures policies that affect his/her specific job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner.

Requirements

High school diploma/GED required
completion of a billing or coding program preferred but not required. Related experience considered in place of billing or coding program.
Must have a minimum of 3 years of experience working in large medical practice and/or billing company; specifically involved in the charge entry, claims processing, claim rejections and claims edit/correction processes.

Responsibilities

Ensures all clinicians charges are completed in timely manner and billed into the Practice Management System daily.
Works as the liaison between the Revenue Cycle Management (RCM) vendor and the operations teams within their assigned practices and/or clinicians.
Runs and monitors the daily charge reports and assures that charges balance and units are correct.
Escalates errors to the vendor partner or practice for resolution within the key performance indicator (KPI) time frames.
Works with the vendor on any claims that are not billed and escalates to RCM leadership and operations leadership for claims that are not meeting the established KPI.
Runs the daily activity report and reviews vs. budget targets.
Notifies RCM leadership on budget variances.
Works with practices if vendor has questions on claims for both pre and post billing.
Ensures that established turnaround times for claim completion and billing are met or delinquent claims are escalated to RCM and operations leadership.
Works with RCM vendor on credit balances that should be applied to charge line items.
Monitors all unbilled claims and works with the vendor and/or practice to resolve.
Run reports as requested by management teams or finance.
Compares monthly actual charges to budget and prepares reports detailing any budget shortfalls.