Munstereyecare.com



Position: Billing Team LeadDepartment: BillingReports to: Practice Manager and Corporate OfficerJob Summary: This individual is responsible for assisting the Practice Administrator with creating and maintaining efficient billing and collection activity in the practice; maintaining the billing department database protocols and reference guides; maintaining current billing and coding files in the practice management system; and maintaining the corporate insurance contracts with regards to fee schedules, payment guidelines, authorizations and plan participation.Education and Experience:High School diploma and college degree in health care administration. Previous healthcare work experience preferably in office settingOCS certification in ophthalmology.Essential Skills and Abilities:Proficient in Excel, Word, and Outlook.Effective communication with physicians, practice manager, employees, business contacts and the public through grammar, telephone and writing.Personal Skills: Highly motivated, organized with attention to detail, able to handle multiple tasks, able to work under minimal supervision, trustworthy, team player, dedicated, accountable and appearance must be neat and professional.Responsibilities:Contracts:Credentialing:Insurance contractsHospitals and Surgery CentersNew doctor Doctor terminationMaintain CAQH database for providers (every 120 days)Maintain provider ID’sNPIMaintain PECOS registrationReview new contracts for participationDemographics(lives and area covered)Fee scheduleReview content of contractReview fee schedules with administrator for reimbursement levels annuallyReview Provider Manuals for updates or changes on a quarterly basis. Maintain insurance fee schedule database Obtain current and new fee schedules for medical and vision planUnderstand reimbursement rules-codes payable and filing limitUnderstand and maintain plan participation for contracted insurance companies: HMOPPOMedicare AdvantageMedicareMedicaid (according to Indiana Medicaid AKA IHCP-Indiana Health Coverage Program Cheat Sheet)Maintain Insurance Provider Reference DatabaseInsurance Provider ManualInsurance Consultation spreadsheetInsurance Eye Code spreadsheetInsurance Authorization spreadsheetInsurance contract termsBillingUnderstand the key components of the Medicare/Medicaid programs as it relates to Ophthalmology Understand the key components of our most common commercial carriers as it relates to OphthalmologyComplete Billing Department Monthly Analysis. Run Office Production report to analyze doctor utilization of codes and record in production spreadsheet. Maintain an efficient and profitable billing, coding and collection process as directed by our financial policyMaintain Medical Coding ManualOversee billing department policies and procedures for efficiency and to maximize reimbursementSet-up and maintain direct deposit accounts for insurance companies and MECA.Maintain release of patient protocol and coordinate policies and procedures with Practice Administrator in order to make necessary write-offs and refundsIdentify low payer, slow payers and delinquent payers(billing specialists to report to supervisor)Maintain PQRI protocolUpdate measure annually or as needed in practice management systemUpdate routers, CPT database, and staff training Maintain E-RX protocolRun provider usage report monthly Set up new user profiles in practice management systemMaintain computer edit issues for the billing departmentEnter new CPT codes into the practice management systemFollow fee calculation protocol Implement all correspondence as it relates to Ophthalmology for:Medicare list serves and bulletinsMedicaid bulletinsVSP global newsEyeball to Eyeball news letterMaintain the ICD-9/10 Coding Cheat Sheet in the practice management system to reflect annual changes in OctoberUpdate and maintain Botox payment allowance on a quarterly basis and make appropriate adjustments to the fee schedule and practice management system. Inform staff of updates on fees.Update and maintain taxonomy codes twice a year (July 1st and Jan 1st). Verify the necessity for pre-certifications for surgeries and post cataract glasses if needed. Address billing issues with outside consulting firms or ophthalmic organizationsIAO help formMaintain banking protocol to prevent theftMaintain and understand the key components of the Medicare Advantage Plans as they relate to Ophthalmology Address and correct any serious edit or denial issue we have with clearing houses when processing claims.Handel all claim audits from insurance companies.Maintain Payor ID Protocol with Front Desk Manager (Back-up)Human ResourcesUpdate and monitor billing department job descriptions for billing supervisor and billing specialistsConduct employee reviews on annual basis Back-up to Billing Specialist due to illness, vacation, or problem resolution.Train all new employees for HIPAA privacy and securityHIPAA – Privacy and SecurityMaintain HIPAA privacy and security manualUnderstand when to execute a Business Associate Agreement (BAA) between business entitiesAnnual training Eagle Associates: The Advisor – distribute to and collect from all employeesKeep current on rules and regulations – Read monthly Eagle Associates The Advisor publicationsRun and monitor Control Scan for Transfirst system.Online administrator for all websites for employeesAssign user IDs and passwords for insurance websitesReset passwords if needed (employees cannot log on)Inactivate/terminate passwords when no longer needed or employment endsMaintain Medical Records protocol and electronic manual formsMaintain and update any documents that have to do with billing or HIPAA posted in the display board in the main office lobby.Miscellaneous Office Operations:Maintain protocol for deleting duplicate accounts and deleting transaction errors for billing department, front desk, and optical. Responsible for front desk and optical transactionsBackup supervisor in the absence of front desk supervisor as it pertains to billing and collectionsMaintain forms and protocol for the use of office waivers:ABNDMEMedicarePatient Liability WaiverMedicaidFinancial Hardship WaiverMaintain practice management billing protocol according to database instructionsAssess the need for practice management system updates from Compulink every six months: version updatesMaintaining diagnostics for the practice management systemMaintain and organize billing department database Maintain and organize billing department interface forms on practice management systemMaintain and inform staff of the patient financial programs we offer.Billing SuppliesOrder all billing suppliesEnvelopes StatementsClaimsReturn envelopesCPT & ICD-10 reference booksCMS 1500 formsOphthalmic Coding Series books and flashcards. Electronic Health Records (EHR) Forward all meaningful use objectives to CMS to obtain incentive paymentVerify compliance under all meaningful reports from practice management systemUpdate EHR tables/custom tables in practice management systemMaintain process within practice management system for electronic routerSaved, admin drive, corporate data folder, human resources, job descriptions folder, business office, billing manager, 07/15/13, njm ................
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