At Virginia Garcia Memorial Health Center, we welcome diversity; we encourage, uplift, and are honored to serve people who have been historically underrepresented and underserved. Our mission is to provide high-quality, culturally appropriate healthcare to low-income residents of Washington and Yamhill Counties, with a special emphasis on seasonal and migrant farm workers and others with barriers to receiving healthcare. We strive to provide an inclusive environment that welcomes and values the diversity of the people we employ and serve.

If you are unsure whether you meet all of the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply.

Job Summary: The Billing Manager manages and oversees the Billing Group within the Finance Department. This position participates in the development and implementation of billing and revenue cycle operating policies and procedures, and audits current procedures to monitor and to improve efficiency of billing and revenue cycle operations. The Billing Manager oversees the hiring, supervision, and training of the billing staff.

Essential Duties and Responsibilities:

• Develop and implement policies and procedures applicable to billing and revenue cycle operations.
• Oversee management of the day-to-day operations of the Billing Group ensuring adherence to policies and procedures.
• Oversee the hiring and supervision of personnel, which includes work allocation, training, and problem resolution; evaluate performance and make recommendations for personnel actions, including termination; motivate employees to achieve peak productivity and performance.
• Work with CFO to establish departmental goals and timelines and update CFO monthly on whether the goals have been met; inform CFO as soon as possible if there are barriers to meeting goals.
• Oversee and optimize enrollment efforts, including managing and improving processes that assist our patients in Medicaid, Medicare, and Marketplace health insurance enrollment
• Develop, implement, and manage quality control, follow up, reconciliation, and audit procedures to ensure accuracy in coding data entry, cash receivables, and billing.
• Participates in compliance meetings representing the revenue cycle and submitting supporting material as it pertains to Medicare Billing and Cost Reporting, Medicare Credit Balance Reporting, and participates in all financial audits as requested.
• Manage the timely implementation of new billing codes and changes in pricing.
• Manage performance of the team, conduct monthly meet ups and provide real time and consistent coaching with all direct reports.
• Ensures accountability of team, including but not limited to adherence with policies, procedures, guidelines, workflows, etc., addressing attendance, performance, and behavior concerns including corrective action if necessary.
• Consult with Human Resources to support employee relations, performance achievement, training, employee engagement, etc.
• Manage time off request and approve timecards for direct reports or as delegated, and monitors to ensure staff takes required breaks and lunches.
• Support annual updates of fee schedules and sliding scale fees as necessary, and in support of the development of annual operating budgets.
• Support and management of the Billing Department annual budget.
• Provide support to the CFO as it pertains to contract renewals for all payer contracts.
• Develop, implement, and manage audit procedures to ensure accuracy in coding, data entry, cash receivables, and billing.
• Work with CFO and other staff in the planning, implementation, and evaluation of modifications to existing operations, systems, and procedures, especially those related to reimbursement maximization and collection of accounts receivable.
• Monitor accounts receivable; respond as needed to accounts receivable problems.
• Maintain the tables and information in the practice management system that supports patient and insurance billing. Keep current on updates to the practice management software and communicate changes to staff. As needed, work with practice management software vendor and clearinghouse to solve billing problems.
• Oversee clinic’s collection programs. Monitor and evaluate program effectiveness and progress and work with Controller and/or CFO on improvements and changes. Act as the liaison with the collection agency and monitor performance of the collection agency.
• Coordinate with CFO on needed training for providers in coding and maximizing reimbursement.
• Handle patient complaints about fees and billing and decide upon the disposition of these complaints.
• Handle complaints and quality requirements relating to billing department function from insurance carriers and other third-party payers and decide upon resolution strategies for these complaints.
• Work as liaison with other departments, to facilitate problem solving and data collection appropriate to patient and insurance billing.
• Ensure that all billing and collection activities meet and adhere to Medicare, Medicaid, and other insurance regulations, rules, and laws.

• Participate in performance improvement projects as assigned.
• Participate in meetings and committees as assigned.
• Attend and participate in staff meetings and required education programs.
• Attend and participate in management team meetings.
• Follow clinic-wide and departmental policies and procedures.
• Adhere to all applicable laws and regulations.
• Maintain confidentiality within the workplace and within the community.

• Perform other job duties as assigned.
• Handle protected health information in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

HIPAA Requirements:

The Billing Manager will have access to PHI in the course of his/her duties. The Billing Manager uses PHI for all aspects of billing, patient’s accounts and communications with insurance companies. Applying the minimum necessary standard of HIPAA, the designated record sets to which this employee will have access to: all information in the practice management system, the full medical record, end of day reports from the practice management system, encounter forms, all communications from insurance companies, all collections information.

Knowledge, Skills and Abilities:

• Ability to supervise and train employees, to include organizing, prioritizing, and scheduling work assignments.
• Ability to use independent judgment and to manage and impart confidential information.
• Knowledge and understanding of medical billing and/or coding systems, as appropriate to the position.
• Knowledge of Federal, State, and payer regulations regarding medical billing compliance.
• Knowledge of computerized information systems used in medical and dental billing.
• Ability to effectively communicate information, policies, and/or procedures in a manner easily understood.
• Commitment and alignment to Virginia Garcia’s mission, vision and values.
• High degree of confidentiality, integrity and professionalism.
• Ability to develop, plan, and implement short-and long-range goals.
• Ability to foster a cooperative work environment.
• Employee development and performance management skills.
• Skill in the use of computers.
• Ability to communicate effectively, both orally and written.
• Able to effectively communication in English verbal and writing.
• Bilingual English/Spanish both verbal and written a plus.

Education and Experience:

• BA/BS in Business Administration or equivalent required.
• Coding Certificate preferred.

• Minimum of 5 years’ experience in management level of supervision required, with prior training experience.
• Experience in medical/behavioral health/dental billing (ICD-10 CPT and HCPCS).
• EPIC software experience preferred.
• FQHC/PPS/Capitation Billing experience preferred.

Behavioral Competencies:

Accountability

• Role model VG’s mission, vision, and shared values

Customer-Focus

• Listen to the voice of the customer and strive to delight them by exceeding their expectations

Teamwork

• If someone needs help, help them

Initiative

• Be innovative, apply fresh ideas, and continuously improve how you do your work

Confidentiality

• Maintain strict confidentiality and respect the privacy of others

Ethical

• Demonstrate integrity, honesty, and stewardship in all encounters at work

Respect

• Demonstrate consideration and appreciation for co-workers and patients

Communication

• Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others

Physical Requirements:

• Standing: up to 30%
• Walking: up to 30%
• Sitting: up to 90%
• Bend, Reach, Stoop: 5%
• Use of Computer: 90%
• Must be able to lift/carry up to 10 lbs.

Immunization:

Staff member must meet immunization requirements as stated in VGMHC’s immunization policy and state and federal guidelines.

Job description represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC’s Mission.

VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes affirmative action in the area of placement, promotion, transfer, rate of pay and termination..

Experience

• Minimum of 5 years experience in management level of supervision with prior training experience.

Education

• Bachelors or better in Finance or related field

Licenses & Certifications

• Cert Coding Specialist

Skills

• Billing
• Epic Billing
• Training