Medical Billing Manager

MEDICAL BILLING MANAGER

Classification : Non-exempt, Full Time

Department : BLACK Doula Network

Reports To : Contracts Administrator

Compensation : $32.50-$38.50 per hour

Travel Requirements : Local travel as required

Supervisory Responsibilities : None. Individual contributor

ORGANIZATIONAL BACKGROUND

BWPC is a research-driven social enterprise founded to make equitable policies and programs more effective. BLACK Wellness and Prosperity Center promotes Belonging, Love, Affinity, Community, and Kinship through culturally congruent system improvements across the prenatal to postnatal continuum of care to advance improved outcomes in maternal health and wellbeing for Black women / persons and their families.

BWPC upholds racism as a root cause of adverse maternal child health experiences for Black women and babies, particularly, the negative impacts of Anti-Black Racism throughout the life course.

BWPC CREDO

BWPC is fact based and centered on trust & equity. If you have a question, ASK. Please do not make assumptions. If you have a concern, SHARE IT.

Please do not spread gossip in the community or within the team. There are no BWPC "cliques." We are ONE. BWPC encourages and promotes deep transformative thinking.

BWPC POWER-SHARING FRAMEWORK

• Generate recommendations for process improvements whenever appropriate
• Participate in developing best practices, sharing resources, and ongoing trainings
• Ensure that all materials created are consistent with BWPC mission, vision, and values
• Participate in the design of new programmatic initiatives
• Apply the BWPC Credo

POSITION SUMMARY

The Medica l Billing Manager contributes to the strategic expansion of our BLACK Doula Network. This is an exciting new position within the organization and is responsible for establishing a new medical billing department for doulas and other billable services.

This is a full-spectrum position that requires A-Z functional, technical, and administrative responsibilities. Department size / staffing will increase as patient load increases.

DAY-TO-DAY RESPONSIBILIES

• Establish a new billing department , including billing / coding processes and workflows
• Develops processes and procedures structured to optimize reimbursement, limit liability, and enhance data integrity
• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and / or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes
• Monitors and reviews all medical records to ensure medical coding accuracy, including proper completion and documentation of rendering signatures
• Notifies rendering providers of missing information and follows up accordingly
• Assesses encounter documentation using Center for Medicare and Medicaid Services (CMS) documentation standards. Based on the provider's documentation, identify possible documentation changes that would more accurately account for services provided if implemented
• Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD / NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers
• Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate
• Performs other duties as assigned

JOB DIMENSIONS

Leadership : Ability to effectively lead and take responsibility for all facets of new department implementation

Decision-Making : Ability to work in ambiguous environment and make logical decisions within position scope of authority

Work Standards : Maintains regular attendance and punctuality

Technical Skills : Ability to quickly learn and use new software

Collaboration : Ability to work with minimal supervision and collaboratively; ability to take constructive direction and guidance from administration

Flexibility : Ability to be flexible, available, accountable, responsible, reliable, adapt to change, work in a fast-paced and demanding environment

Comprehension / analysis : Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Ability to read and comprehend instructions, correspondence, and memos. Ability to analyze, organize, document, and communicate the specific needs of each unique targeted population

Trustworthiness / Integrity : Ability to at all times use discretion, maintain confidentiality, protect Protected Health Information (PHI), not disclose Personal Identifiable Information (PII), and exhibit ethical conduct

Stress Tolerance : Ability to administer self-care and have an awareness of when personal wellness needs to be acknowledged and addressed

EDUCATION

High School diploma or equivalent. 1-4-year degree in healthcare or related field preferred.

EXPERIENCE

3-5 years of direct OB / GYN billing and coding experience. 1-3 years of billing and coding department management.

LICENSES AND CERTIFICATIONS

Required : Certification as Certified Professional Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist Physician-Based (CCS-P)

REQUIRED QUALIFICATIONS AND WORK EXPERIENCE

• In-depth understanding of both the medical and business side of billing operations
• Highly organized, self-motivated, detail-oriented, and energetic team player
• Ability to multi-task in a fast-paced environment
• Background with Medi-Cal, Medicare, managed care, and PPO insurance
• Detailed knowledge of medical terminology
• Ability to read / interpret correspondence, charged documents, EOBs and all insurance forms
• Knowledge of online registration procedures, including payor data and financial classes
• Superior intrapersonal and interpersonal communication skills
• Proficient technical and computer processing skills using Microsoft and Excel
• Ability to master new software

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear.

The employee frequently is required to use hands or fingers, handle, or feel objects, tools or controls. The employee is frequently required to stand;

walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and / or move up to 25 pounds.

Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.

The noise level in the work environment is usually moderate. The emotional environment will include hearing, seeing, and discussion of racism, mortality, and maternal child health inequities.

BWPC frequently conducts work in hospital and clinic settings and may offer on-site healthcare services, such as COVID-19 testing.

Requires frequent oral and written communication with internal and external stakeholders, vendors, and partners, the ability to enter data and written communications in electronic format in a timely manner using various software.

Ability to consistently reach the worksite, meetings, and events on time and prepared to work.

WORK METHODS

• In-person
• Reports to : Contracts Administrator

COMPENSATION AND PAY SCALE

Non-exempt, hourly. Pay grade III-A. Range $32.50-$38.50 based on skills and experience.

EQUAL OPPORTUNITY STATEMENT

Black Wellness & Prosperity Center is an equal opportunity employer, drug free workplace, and complies with ADA regulations as applicable and shall not unlawfully discriminate against any employee or applicant for employment because of race, religious creed, color, national origin, ancestry, physical disability, mental disability, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, military status or veteran status pursuant to all applicable State of California and Federal statutes and regulation.

BWPC does not discriminate against applicants or employees because of their reproductive health decision making.