General Summary:
Under the direction of the Finance Director, the Outpatient Billing Supervisor is responsible to maximize all possible sources of reimbursement by generating timely and accurate bills for Medicare, Medicaid, Children's Waiver, Serious Emotional Disturbance (SED) Waiver, Habilitation Supports Waiver (HSW), Autism, County of Financial Responsibility (COFR) and First- and Third-party insurances.
This position functions to oversee the posting of cash receipts to the proper consumer accounts and insurances, ensure the timely and accurate payment of claims submitted through the ERM system to LifeWays provider network, and manage the credentialing/paneling of LifeWays staff to ensure accuracy of billable claims.
Essential Functions:
Responsible for day-to-day supervision, counseling, and discipline of direct staff according to procedure.
Also responsible for performance evaluations, initial 90-day period for (direct report) new employees and annual thereafter.
Works in collaboration with Clinical Care Services leadership to ensure appropriate administrative and fiscal workflow.
Oversight of all physicians/clinicians, including tele-medicine contractors, are appropriately credentialed with all applicable insurance carriers upon hire, and throughout their employment with LifeWays to ensure 100% billable claims.
This includes completion of credentialing and paneling in a timely manner as well as working with finance staff to identify and problem solve any barriers or rejected claims.
Secures payer authorization, verification, copay, and deductibles prior to service delivery.
Ensures compliance with the welcoming standards as outlined by LifeWays' Community Mental Health Services Program (CMHSP) Contract with the Michigan Department of Health and Human Services (MDHHS).
Maximizes all possible sources of reimbursement by generating timely and accurate bills for Medicare, Medicaid, Children's Seriously Emotionally Disturbed Waiver (SEDW), County of Financial Responsibility (COFR), and First-and Third-Party Liability insurances.
Assures accuracy of monthly billings for self pays, payments applied to accounts from self pays and insurance companies, and adjustments to accounts, and handles discrepancies.
Reviews and proposes write-offs of Third-Party Liability billings.
Verify the updates to contractual rate changes in the Electronic Health Record (LEO).
Processes regular accounts receivable updates.
Develops and maintains systems for claims and billing, accounts receivable reconciliations, account audits, and internal controls.
Manages the credentialing for insurances and National Provider Identifier (NPI) for billable staff (new hires) within the organization.
Monitors activities for and ensures compliance with government and insurance laws, regulations, and procedures.
Facilitates the education and training to eligibility staff and providers regarding billing guidelines and code requirements.
Travel is required and generally occurs in Jackson and Hillsdale counties but travel within the State of Michigan may be necessary.
Facilitates in the development and refinement of reimbursement educational materials to improve provider readiness to properly bill for services either directly to an outside pay source or to LifeWays claims department.
Maintains regular and predictable attendance.
All other duties as assigned.
Required Education/Certification/Licensure:
CHAMPS training, upon hire.
Medical billing/coding certification, or able to acquire within 9 months of date-of-hire.
Bachelor's degree in related field, or equivalent experience.
Preferred Education/Certification/Licensure:
Master's degree in related field.
CPC Certification
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