Lead Billing Specialist

Health Services of North Texas Inc•Denton, TX

2d•Hybrid

About The Position

Job Summary: The Lead Billing Specialist supports HSNT by performing assigned duties within billing and revenue cycle management functions. Internal: The Lead Billing Specialist performs duties associated with the billing process while adhering to HIPAA compliance, privacy, and confidentiality standards. The Lead Billing Specialist must be able to complete all functions associated with the Medical Billing Specialist and II role in addition to the essential functions listed below, (see Medical Billing Specialist and II Job Description. External: The Lead Billing Specialist role within the community is to promote HSNT through its communication channels. Essential Duties/Responsibilities: Provide efficient and effective account receivable services on behalf of our member clients to maximize their reimbursement and support HSNT revenue cycle performance indicators for financial health. Develops detailed departmental, team and individual goals designed to meet external and internal HSNT performance expectations, enhancing the organization’s role and a premiere service provider. Adapts programs and services to enhance this organization’s ability to serve the needs of the community. Communicates all goals as well as program/service adaptations with clear reasoning/justification as well as departmental, team and individual roles and responsibilities. Ensures the integrity of program and service delivery, compliance and evaluation and moves to adapt programs/services as compliance standards change in an effective and efficient manner. Ensures compliance with internal standards and goals, all contract/grant specifications, as well as licensing, regulatory and accreditation standards including but not limited to TMHP regulations, HRSA and UDS, Medicaid, Medicare regulations etc..... Ensures all Local/ County, State, Federal and laws and regulations are being followed. Acts with urgency and professionalism when dealing with program, team or employee concerns/issues and includes, through on-going communication, all appropriate organization representatives as needed. Assumes a leadership role and acts as a team member of the organization in the interpretation and support of organization policies (including HR, PR and Communications), implementation of industry best practice standards throughout assigned programs, aiding in the development/implementation of program outcome measures to ensure quality service implementation. Responsible for directing and coordinating the functions of the billing office to ensure maximization of cash flow while improving client, clinical staff, and other customer relations. Delivers results against a defined scope of work with measurable ROI, strategic innovation, coupled with performance reporting and employee development. Prepares aging and various other revenue reports for management. Reviews month-end AR Analysis Report for Bad-Debt Expense adjustments, Aging Percentages, Bad Debt/Percentage of Revenue and future aging impact. Develops and manages relationships with insurance companies and other funder representatives. Assists EHR billing system to its farthest functionality to reduce manual processes. Identify bottlenecks and duplicative steps in various processes; identify and develop streamlined solutions. Communicates relevant organization/client/insurance information to the team on an ongoing basis through regular team meetings, and one-on-one communications and feedback. Develops and maintains relationships with organization management team members; communicate and collaborate to improve processes that are interconnected. Ensures that each team member is cross trained to have the knowledge and capability of completing all tasks with the Revenue Cycle team. Perform other duties other than those indicated above assigned by their manager.

Requirements

Exhibit excellent customer service skills including effective problem solving and follow-up.
Demonstrated knowledge of EMR, billing codes, medical and insurance terminology
Strong communication skills, verbal and written.
Adaptable, flexible, and able to handle stressful situations professionally.
Ability to promote teamwork, quality patient centered care and judicious use of resources.
Demonstrated ability to multi-function; set goals and establish priorities.
Proficient computer skills with demonstrated ability to utilize Microsoft products inclusive of Excel.
4-10 years professional experience in a billing department, with at least 3 years in a lead capacity.
Prior healthcare third party billing/collections experience with superior knowledge of government billing
Minimum of a high school diploma or GED is required. Some higher education is preferred.
ICD-9 / ICD 10 / CPT / HCPCS coding knowledge.
Extensive experience with eClinicalWorks and Clearinghouse Software
Significant knowledge of Medicare, Medicaid, and 3rd Party Insurance Regulations/Compliance/Laws
Demonstrated managerial capabilities.
Ability to prioritize workflow, problem solve and identify best possible solution, maintain knowledge on assigned accounts.
Ability to work in a fast-paced, always changing environment.
Excellent organizational, analytical, communication, and interpersonal skills required.
Ability to work independently and efficiently from a home office environment
High Speed Internet Service
It is a requirement that employees work in a distraction free workplace
The activity for this position requires the employee to work in-person onsite in a clinical setting.
Must be able to move, transport, position, and lift up to 15 pounds as needed.
Must be able to remain in a stationary position such as standing or sitting for up to 8 hours per day.
Must be able to walk, move, and/or traverse as needed.

Nice To Haves

Experience working with Federally Qualified Health Clinics highly preferred
Medical billing/coding certification preferred.
Bilingual a plus.

Responsibilities

Provide efficient and effective account receivable services on behalf of our member clients to maximize their reimbursement and support HSNT revenue cycle performance indicators for financial health.
Develops detailed departmental, team and individual goals designed to meet external and internal HSNT performance expectations, enhancing the organization’s role and a premiere service provider.
Adapts programs and services to enhance this organization’s ability to serve the needs of the community.
Communicates all goals as well as program/service adaptations with clear reasoning/justification as well as departmental, team and individual roles and responsibilities.
Ensures the integrity of program and service delivery, compliance and evaluation and moves to adapt programs/services as compliance standards change in an effective and efficient manner.
Ensures compliance with internal standards and goals, all contract/grant specifications, as well as licensing, regulatory and accreditation standards including but not limited to TMHP regulations, HRSA and UDS, Medicaid, Medicare regulations etc.....
Ensures all Local/ County, State, Federal and laws and regulations are being followed.
Acts with urgency and professionalism when dealing with program, team or employee concerns/issues and includes, through on-going communication, all appropriate organization representatives as needed.
Assumes a leadership role and acts as a team member of the organization in the interpretation and support of organization policies (including HR, PR and Communications), implementation of industry best practice standards throughout assigned programs, aiding in the development/implementation of program outcome measures to ensure quality service implementation.
Responsible for directing and coordinating the functions of the billing office to ensure maximization of cash flow while improving client, clinical staff, and other customer relations.
Delivers results against a defined scope of work with measurable ROI, strategic innovation, coupled with performance reporting and employee development.
Prepares aging and various other revenue reports for management.
Reviews month-end AR Analysis Report for Bad-Debt Expense adjustments, Aging Percentages, Bad Debt/Percentage of Revenue and future aging impact.
Develops and manages relationships with insurance companies and other funder representatives.
Assists EHR billing system to its farthest functionality to reduce manual processes.
Identify bottlenecks and duplicative steps in various processes; identify and develop streamlined solutions.
Communicates relevant organization/client/insurance information to the team on an ongoing basis through regular team meetings, and one-on-one communications and feedback.
Develops and maintains relationships with organization management team members; communicate and collaborate to improve processes that are interconnected.
Ensures that each team member is cross trained to have the knowledge and capability of completing all tasks with the Revenue Cycle team.
Perform other duties other than those indicated above assigned by their manager.