Billing Supervisior

Behavioral Health Network • Springfield, MA

245d

About The Position

The EHR Billing Matrix Supervisor has responsibility to design and maintain the billing matrix contained in the electronic health record. The EHR Billing Matrix Supervisor will work with the EHR Architect or their designee and program staff to design sustainable billing models to facilitate claims submission for new and existing programs. The EHR Billing Matrix Supervisor will have a high-level overview of all billing setups, payer fee schedules, covered procedures and ensure that the setups are compatible to ensure compliance with Commercial, state, and federal billing guidelines. In addition, the EHR Billing Matrix Supervisor will need the ability to communicate with the impacted key stakeholders, billing staff, and the EHR team regarding the designs and matrix builds. In conjunction with the Vice President, the EHR Billing Matrix Supervisor considers the long-term needs of BHN and through design and planning strives to meet the strategic goals, policies, and procedures of the Billing Department.

Responsibilities

• Meets with key stakeholders and the EHR architect or their designee to evaluate program design, analyze billing options, and propose a billing framework for new program development.
• Designs billing frameworks including fee schedules, procedure code creation, modifier build based on clinical licensure as identified by each funding source requirement, and establishes roll up rules to aggregate multiple units into claims as designed by the funding source.
• Understands the variations in funding source expectations and service coverage including awareness of the difference between inpatient and outpatient services as they correlate to UB and HCFA claim forms.
• Ensures the waterfall functionality of the EHR is operational to maximize automation and reduce manual workflows.
• Maintains functionality for staff with multiple active clinical license levels so that the correlating and correct license level is attached to the claim as determined by payer rules and maximizes revenue.
• Supervises Billing EHR support staff and performs all relevant supervisory duties such as performance reviews, timesheet and mileage approvals, and progressive disciplinary actions.
• Organizes and allocates tasks among the Billing EHR support team and coordinates their work.
• Using feedback from the cash posting and AR staff, evaluates the accuracy of posted fee schedules.
• Using write off trends, analyzes, and modifies the EHR setups to maximize their accuracy and add additional internal procedure codes to identify and label the reason for the failing claim.
• Reviews claims intentionally set to fail and makes required adjustments to allow services to be reprocessed or written off, as appropriate.
• Identifies and establishes programs that require authorization and turns on that functionality for the procedure codes identified.

What This Job Offers

• Industry: Nursing and Residential Care Facilities