Healthcare Billing and Reimbursement Manager

Texoma Community Center•Sherman, TX

About The Position

Directs and supervises claims and provider reimbursement personnel. Establishes procedures for filing reimbursement claims and ensures claims are paid accurately and on time. Monitors, evaluates, and reviews reports supporting reimbursement claims. Develops policies and procedures that comply with fiscal and regulatory requirements and accepted accounting principles, and updates billing software with rates, codes, and procedures. Serves as the primary contact with Managed Care Organizations (MCOs), Medicaid, Medicare, and commercial insurance plans, including for contracting, rate negotiation, dispute resolution, and staff roster submissions. Oversees policies and procedures for client financial assessments and fee collection, including maximum monthly fees, copays, and deductibles. Provides oversight to Center staff on training and completion of client financials, customer service, and collections. Assists with developing and reconciling cost reports and other required state reporting, and may assist a supervisor or other Center staff with special projects or assignments. Operates under trauma-informed and recovery-oriented models of care aligned with CCBHC standards.

Requirements

Four years of supervisory responsibilities.
Excellent communication and organizational skills, with the ability to interact professionally with staff, clients, and community and State agencies.
Extensive knowledge and skill in Microsoft Office, including Word, Access, and Outlook.
Current driver’s license and a vehicle for use while at work.
Ability to add, subtract, multiply, and divide.
Ability to handle money and make change.
Ability to generate, read, interpret, and act on basic financial statements, national and state regulations, and operational, maintenance, and organizational policies and procedures.
Ability to communicate effectively and work cooperatively to maintain good working relationships.
Ability to identify problems.
Ability to protect confidential information in accordance with organizational privacy policies and regulations.
Consistently practice a trauma-informed model of care and understand and consider the pervasive nature of trauma.
Knowledge of cultural differences and ability to work with individuals from different cultural backgrounds.
Must be self-motivated, organized, and detail-oriented.

Nice To Haves

Bachelor’s degree with major coursework in Business; education and experience may be substituted.
Experience working with individuals with mental illness and/or addiction issues.
Ability to speak a second language relevant to the population served.

Responsibilities

Direct and supervise claims and provider reimbursement personnel.
Set procedures for filing reimbursement claims and ensure timely, accurate claims payments.
Monitor, evaluate, and review reports supporting reimbursement claims.
Develop policies and procedures compliant with fiscal and regulatory requirements and accepted accounting principles.
Update billing software with rates, codes, and procedures.
Serve as the main point of contact with MCOs, Medicaid, Medicare, and commercial insurance plans for contracting, rate negotiation, dispute resolution, and staff roster submissions.
Oversee policies and procedures for client financial assessments and collection of fees, including maximum monthly fees, copays, and deductibles.
Provide oversight to Center staff regarding training and completion of client financials, customer service, and collections.
Assist in developing and reconciling cost reports and other required state reporting.
Assist a supervisor or other Center staff with special projects or assignments as needed.
Operate under trauma-informed and recovery-oriented models of care aligned with CCBHC standards.