General Statement of Duties:

Provides oversight, supervision, technical direction, and administrative leadership in the areas of insurance contracts, reimbursement and accounts receivable.  Coordinates the daily operation of the Board’s billing and accounts receivable functions.  Manages the reimbursement/accounts receivable functions within the electronic health record (EHR) software and serves as primary contact for reimbursement-related service changes and updates.  This position reports to the Controller.

This position is classified as exempt under the provision of the Fair Labor Standards Act.

Major Duties and Responsibilities:

  • Serves as a reimbursement liaison and named contact in contracts with third-party payers, including but not limited to for Medicaid, managed care companies, commercial insurance companies, etc.
  • Negotiates contracts for services with third-party payers, especially for services which are not normally considered in the contract renewal which are specific to the CSB.
  • Maintains/updates the billing matrix, billing payers, billing payer types, adjustment types, minimum fee on service types, credential groups, etc.  May update the revenue code matrix.
  • Assists in hiring and supervises staff and directs day-to-day functions related to reimbursement.
  • Provides oversight and staff supervision for activities associated with accounts receivable, direct and third-party billing, and fee collection.
  • Responsible for completing performance reviews on direct reporting staff.
  • Identify and prioritize outstanding reimbursement issues; update processes and /or polices as needed.  Work with staff to develop and train the skills and knowledge within the team.
  • Manages the reimbursement and accounts receivable functions within the EHR software.
  • Interprets, implements, and assesses staff compliance with related Board policies and procedures. Maximizes fee revenue within Board policies and procedures, and usual and customary practices.  Recommends changes to reimbursement policies and process to Controller for review.
  • Ensures the CSB is maximizing fee collections in compliance with internal and external policies (DBHDS) and standards of practice;
  • Coordinates, as well as participates in all phases of the reimbursement system, as needed. Cross trains with all staff reimbursement functions.
  • Monitors overpayments and unapplied payments and refunds appropriate balances, in accordance with Board policy and guidelines; maintains fee liability schedule for Arbor House; may coordinate financial interviews, set fees, collect fees, etc.
  • Performs regular review of accounts receivable and coordinates appropriate follow-up of outstanding accounts, consistent with established guidelines and procedures. Manages collections of direct client payments and subsequent procedures/activities including write-offs, adjustments and/or pursuit of additional collection procedures (legal action, set-off debt, etc.); directs appropriate action to resolve unpaid claims, delays, denials, or other problems in payment from third-party payers.
  • Provides ad-hoc reporting in the EHR as requested.
  • Implements and monitors procedures for the proper posting, billing, collecting and aggregate reporting of reimbursable services.
  • Maintains and supports internal controls for all activities in the Reimbursement Area including account receivable, collections, write-offs and any other activities as identified.
  • Monitors and ensures CSB compliance with payer rules, regulations and industry standards. Proactively identifies problems and areas of potential non-compliance to supervisor/ management, and works to resolve/correct these items consistent with an approved plan of correction;
  • Identifies accounts for various CSB programs for write-offs. Controller approves all account write-offs prior to processing.  Position is responsible for making adjustments within software.
  • Serves as the liaison between Reimbursement team and Information Technology for clearing house issues.
  • Trains and development of reimbursement staff, provide cross training. Establishes written procedures and maintains current versions on network drives for all payer types.
  • Provides excellent customer service to peers, clients, clinical staff, auditors, and others stakeholders;
  • Expands own knowledge of job related areas by such means as academic study, independent reading, and attending outside conferences, workshops, etc.;
  • Maintains effective relationships with co-workers and customers based on courtesy, compassion, and respect;
  • Responsible for other duties as assigned, consistent with established operational policies, procedures, and practices.

Required Knowledge, Skills and Abilities:

  • Knowledge and navigation of billing system including reporting, preferable experience with Credible.
  • Technical knowledge of Medicaid, Medicare, and other third-party payer requirements & regulations, procedures, and systems.
  • Effective supervision of staff in technical areas to ensure staff accountability, efficiency, accuracy, productivity and effective interactions with staff and clients.
  • Make appropriate decisions independently and take related action based on knowledge of Board policies, procedures, and practices.
  • Provide excellent customer service internal and external.
  • Strong organizational skills, excellent communication skills both oral and written; excellent interpersonal skills.
  • Ability to be a team player, use good judgment, tact and courtesy; are dependable.
  • Maintain confidentiality of client and staff at all times.

Minimum Education and Experience:

Completion of high school or GED; Associates degree in business field, prefered; plus, five-eight years of experience in medical reimbursement and/or billing areas utilizing third-party payer systems; supervisory experience preferred; OR any equivalent combination of experience or training which provides required knowledge, skills and abilities.

Other Information:

Equipment: PC and designated software, adding machine/calculator, copy machine, fax machine, and telephone system.

Work Environment: General office environment with normal lighting levels, temperature ranges, air quality, ventilation, and noise levels. 

Work Location: 1241 North Main Street Campus, Harrisonburg, VA.

Work Hazards: Some hazard associated with repetitive motion necessary for data entry/typing; standard hazards associated with human services environment. 

Work Schedule: Monday through Friday, regular office hours 8am to 5pm; additional hours as needed to perform job requirements.  Regular attendance in person is required.  This position is required to take at least five consecutive days of leave each year.

HIPAA Access Level 3: Read-only access to protected health information (PHI), limited to minimum necessary, and full read/write access to demographic and financial information, limited to the minimum necessary, for all clients as part of staff provision of support services in agency health care operations. Staff at Level 3 are allowed to seek out client PHI as necessary to perform assigned duties, but are expected to exercise due precautions to avoid exposure to PHI which is not necessary to perform these assigned duties. Utilization of information will be in accordance with HIPAA regulations regarding use limitation, disclosure and requests of PHI.

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