Overview

Provides general daily management of the Claims and Billing Department. Duties may include, but are not limited to, the following: Develops processes and procedures that will monitor billing outcomes. Oversees the process of charges coming into the Patient Accounts Department. Responsible for analyzing rejections. Oversees the addition of into the Practice Management System. Assists with communications for internal meetings and provides team information as requested. Implements strategies to eliminate errors and reduce the rejection rate. Updates and develops policies and procedures based on billing needs and requirements as necessary. Works with other WAKEMED departments and staff on a daily basis to troubleshoot and resolve day to day operational issues relating to billing and the processing of claims. Responsible for serving as a connection between the Department and other departments within WAKEMED. Allows the access for WAKEMED departments to be able to work in the insurance carriers? websites for eligibility. Approve time sheets and time off. Ability to handle all tasks and projects given and directed by the Patient Account Director. Supervises, assigns, evaluates, trains, and coordinates the work schedules of a clerical staff in the Patient Accounts Services Section; serves as a reference for staff problems. Plans and supervises the activities of the section to ensure proper and timely billing of all accounts; directs the billing of insurance companies, patients, including the responsibility for the processing of claims or denials, the resubmission of denied claims and the appeal process. Assists the Claims and Billing Director in the development of fiscal controls, ensuring conformance with the guidelines and policy of fiscal intermediaries, the hospital and standard fiscal procedures; recommends and implements new or revised methods and procedures to improve billing operations; develops written procedures and manuals to implement changes or clarify standard practices. Reviews current manuals, health regulation updates, and other changes to determine the impact on billing and related functions; presents recommendations in verbal or written form; conducts special studies on matters related to the operation of the section including workflow patterns, error trends, staff and space utilization, equipment needs, training and other areas of concern. Research accounts: resolves or handles the more difficult and complex billing problems, appeals, and complaints. Confers with TPP, department heads, medical staff, supervisors and patients; coordinates the work of the section with other Medical Center Divisions, i.e., Data Processing, Admitting, Medical Records, etc. Prepares and audits claims, statements and reports from a variety of sources; performs technical accounting work; monitors accounts receivable and prepares reports. Provides support to other staff as required.
Department Description


Licensure

Not Applicable
Education

Associate's Degree Business Administration Or Health Administration Required Bachelor's Degree Preferred
Experience

2 Years Leadership And 5 Years Accounting/Finance - Revenue Cycle And Insurance Verification and Authorizations And Accounting/Finance - Billing Required

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