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Director of Medical Billing Services


A fast-growing, dynamic and entrepreneurial company providing a full range of financial management and medical billing services to not-for-profit agencies. By allowing clients to outsource their fiscal operations, we improve the effectiveness and capacity of its mission- driven clients. Client organizations cover the full spectrum of the not-for profit world, with an emphasis on health care and human services providers. We pride ourselveson delivering to its clientele extraordinary service that is both seamless and confidential.



Firm goals are to achieve an average growth rate exceeding 15% over the next six years at which point we will be a business with revenues of $20+ million. In order to achieve this goal, we are embarking on a significant initiative to transform the company. A major component of this initiative is to re-engineer the operating platform; document the business processes; train staff on the processes; monitor for compliance; and continually improve the systems.

This position requires an understanding of medical billing processes and accounting for nonprofit organizations. The Director will manage the Medical Billing unit to ensure the staff operates at the highest levels of accuracy and timeliness. The Director is a liaison between outsourced staff in India and the clients and is required to ensure that historical information is maintained properly. The Director will assist Client Managers and their operations staff, responding to medical billing and collection questions and/or concerns required to meet business needs.

As one of the key members of the senior management team, the Director of Medical Billing Service position is critical to the success of this initiative.

The Director of the Medical Billing Service unit is responsible for the efficient and effective billing and collection of $40M+ for our clients’ medical, dental, mental health service, and residential treatment claims resulting from over 250,000 patient encounters each year.

Main Activities As an integral member of the senior management team, the Director of Medical Billing Service will be responsible to:

General Management
• Establishes department objectives, policies and procedures and evaluates effectiveness
• Hires, trains, supervises, evaluates, and oversees daily activities of Medical Billing staff
• Develop and monitor staff productivity and quality metrics
• Manages and monitors the workflow following agreed upon schedules for: o Submission of Claims to appropriate Insurance Companies o Posting of Payments and Denials o Updating and Verifying Client Billing Reports
• Develops and monitors the systems to ensure the accuracy billing data
• Develops efficient procedures to follow up on submitted claims; monitor unpaid claims; and resubmit claims as necessary.

Information Technology

• Oversees administration and maintenance of electronic billing and remittance software
• Develops and maintains Client Billing Dashboards
• Coordinates new client setup in Practice Management System
• Identifies and Clearly Articulates IT enhancements to reduce manual entry whenever possible

Analysis and Client Support

• Tracks and analyzes reimbursement and denial rationale trends
• Ensure billing reports are reviewed by the Client Manager and Clients and appropriate corrective actions are taken if necessary
• Ensures billing reports are revised and updated as needed to support client business initiatives
• Attends monthly client meetings to provide an overview of all aspects of billing for the client.
• Provides necessary billing reports and transaction level detail reporting for annual audits performed on all clients.

Compliance & Audit
• Verify that transactions comply with department’s Policies and Procedures and all applicable government and insurer regulations
• Ensure strict confidentiality of Protected Health Information (PHI) in compliance with HIPAA regulations
• Maintain all necessary supporting documentation for submissions
• Ensure accurate maintenance of filing system for all financial documents

To be successful in this job an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and ability required.
• Experience: minimum 7+ years of supervisory experience.
• Knowledge: superior knowledge of Medicaid, Medicare, CPT, ICD-9, commercial billing, managed care organization billing, etc.
• Software Skills: Experience with Medical Billing software; Advance Data System (ADS) billing software is a plus. Must be proficient with MS office suite- Strong Excel a must.
• Communication: Clear oral and written communication; listens and gets clarification. Ability to identify problems and communicate to management, team orientated; group problem solving situations.
• Quality: Must be self-motivated; take initiative to oversee all tasks from beginning to end; well organized and detail oriented, accurate and assertive.
• Education: Bachelor's degree Healthcare Services, Health Administration,or equivalent. Masters preferred. Professional Affiliations: AAHAM, HFMA, or HMBA a plus.

Please submit resume with salary history, and cover letter via the email address: Attn: Personnel (confidential)

*Resumes submitted WITHOUT a cover and salary history will not be considered.





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