Job Summary: The Medical Billing Manager is responsible for overseeing and managing the billing operations within the healthcare organization. This role involves leading the billing team, ensuring accuracy in billing procedures, optimizing revenue cycle processes, and maintaining compliance with healthcare regulations. The Medical Billing Manager will collaborate with various departments, healthcare providers, and insurance companies to ensure efficient and accurate claims submissions, follow-ups, and reimbursements.
Key Responsibilities:
· Supervise Billing Operations: Lead, manage, and support the medical billing team in their day-to-day functions, ensuring timely and accurate processing of claims.
· Revenue Cycle Management: Oversee all aspects of the revenue cycle, from charge entry, coding, claims submission, payment posting, and account follow-up to collections.
· Ensure Compliance: Ensure adherence to healthcare regulations, HIPAA, and payer-specific policies. Stay updated on regulatory changes affecting medical billing.
· Claims Management: Monitor and manage the processing of insurance claims, including claim submissions, denials, appeals, and payments. Investigate and resolve billing issues as needed.
· Staff Training and Development: Train and mentor billing staff on best practices, updates in billing processes, software systems, and new healthcare regulations.
· Reporting: Provide regular reporting to senior management on billing performance, key metrics, accounts receivable, and revenue cycle efficiency.
· Vendor and Payer Relations: Work closely with insurance companies, third-party payers, and healthcare providers to resolve disputes and improve payment processes.
· Audit and Quality Assurance: Conduct periodic internal audits to ensure billing accuracy and compliance. Address any discrepancies in billing procedures and make improvements.
· Process Improvement: Identify inefficiencies within the billing department and recommend solutions to streamline processes, improve cash flow, and reduce claim denials.
· Collaboration: Collaborate with the clinical, administrative, and financial teams to ensure smooth operations and revenue flow.
· Bachelor's degree in healthcare administration, business, or a related field (preferred).
· Minimum [X] years of experience in medical billing, revenue cycle management, or a related role.
· In-depth knowledge of healthcare billing practices, coding (CPT, ICD-10, HCPCS), and payer guidelines.
· Strong leadership and team management experience.
· Proficiency in medical billing software and electronic health records (EHR) systems.
· Excellent analytical, problem-solving, and organizational skills.
· Strong communication and interpersonal skills.
· Knowledge of HIPAA regulations and healthcare compliance.
Preferred Qualifications:
· Certified Professional Biller (CPB) or Certified Medical Reimbursement Specialist (CMRS) certification.
· Experience with Medicare, Medicaid, and private insurance billing.