FQHC Billing Supervisor

Families Together of Orange County - Tustin, CA

Full-time - Manager

Tustin, CA

Ambulatory Health Care Services

About the position

The FQHC Billing Supervisor is responsible for timely and accurate billing claim submission to responsible third party payers. This role involves monitoring and developing the Business Office billing staff, ensuring compliance with Medicare, Medi-Cal, Commercial Insurances, and Federal and State Laws impacting health care. The supervisor will monitor and create edits in the electronic billing system to achieve accurate high clean claim ratios and coordinate office efforts closely with the Recovery Supervisor to expedite collections.

Responsibilities

• Supervises Billing Department staff on tasks associated with billing and collection from third party payers.
• Monitors billing processes of billing staff to assure that billing is correct and timely.
• Ensures that all required information is attached to every billing form, TAR.
• Ensures timely submission and acceptance of claims to all payers.
• Elevates issues with payers and reports improvement as appropriate.
• Assists the PFS Director and Recovery Supervisor, performing designated duties when they are absent.
• Assists with the implementation of quality and performance improvement measures for the business office.
• Participates in the development of unit policies and procedures.
• Identifies accounts not selected for billing (ANSB) and reviews system generated billing, collections and medical records abstracting reports to monitor weekly collections, billed and unbilled accounts.
• Identifies and collects on underpaid accounts and recommends future course of action based on data interpretation.
• Reviews Claims Edit List to monitor specific issues, as well as recurring issues and resolution.
• Communicates issues that are preventing timely and accurate billings to appropriate hospital department Manager for performance improvement process.
• Uses a wide variety of communication formats to keep staff regularly informed and trained with one to one and team meetings.
• Serves as a resource to staff by answering questions, assisting with problems, and providing training as necessary.
• Ensures appropriate and professional communication with payers and patients.
• Reviews and resolves issues related to claim generations, clean claim ratios, rejected, denied billings.
• Determines the accuracy of charge capture, missing charges, late charges, covered and non-covered charges.
• Performs other duties as assigned within scope.

Requirements

• Bachelor's degree in Health, Accounting, or related field.
• Certification/license in medical billing or coding.
• Minimum of three years of supervisory billing experience required, preferably in an FQHC setting.
• At least two years of knowledge and experience working with Federally Qualified Health Centers (FQHCs) preferred.
• Advanced knowledge of Excel is preferred.
• Strong oral and written communication skills.
• Ability to work independently and manage critical tasks under deadlines.
• Knowledge and experience with Medicare, Medi-Cal, insurance plans, contract payers, and government entities.

Benefits

• Equal opportunity employer