Cenikor's Value Proposition - What's In It for You?:
SCHEDULE Monday -Friday 8am-5pm
ESSENTIAL FUNCTIONS:
1. Manage complex insurance verification processes including real-time eligibility checks and prior authorization requests for SUD services.
2. Ensure accurate coding of SUD treatment procedures using relevant ICD-10 and CPT codes, considering specific SUD diagnosis and treatment modalities.
3. Prepare and submit clean electronic claims to payers, adhering to billing guidelines and deadlines.
4. Prepare and submit invoices for vendor contracts such as Indian nations, US Courts, VA, etc.
5. Monitor claim statuses, identify and address claim denials promptly, and implement strategies to reduce denial rates.
6. Collaborate with insurance companies to resolve billing discrepancies and appeal denied claims.
7. Regularly analyze key performance indicators (KPIs) like accounts receivable (AR) aging, collection rates, and denial trends to identify areas for improvement.
8. Develop and implement strategies to optimize revenue cycle efficiency and maximize revenue collection.
9. Stay updated on evolving SUD billing regulations, including HIPAA and state-specific requirements.
10. Ensure compliance with billing codes, documentation standards, and patient privacy guidelines.
11. Ensure payments, write off's and adjustments are completed by month end. Any unapplied payments are researched and resolved.
12. Lead and manage a team of billing specialists, coders, cash posters, VOB and A/R specialists.
13. Provide training and support to staff on billing procedures, coding updates, and compliance requirements.
14. Ensure completion of Big 5 performance management tool aby the required deadlines and use of SMART goals to support annual performance compensation review.
15. Uphold the core principles of Cenikor's culture and create a positive working environment for all team members.
16. Maintain strict confidentiality on all client and Foundation matters.
17. Perform additional duties as assigned and consistent with the exempt functions as defined in this job description.
QUALIFICATIONS FOR THE POSITION:
- Deep understanding of SUD treatment modalities, diagnoses, and billing codes.
- Expertise in medical billing practices, including electronic health records (EHR) systems.
- Strong analytical skills to identify trends and implement data-driven solutions.
- Excellent communication and interpersonal skills to interact with patients, insurance
companies, and internal stakeholders.
- Experience in managing a revenue cycle team in a healthcare setting, preferably within the
SUD field.
- Skilled in insurance billing coding and processing.
- Skilled in administrative and clerical procedures, Microsoft Office and ten-key.
- The ability to possess excellent organization and communication skills.
- Ability to be detail oriented and accurately record numerical data.
- Ability to consistently uphold the Core Principles of Cenikor's Culture:
o Demonstrate mission of service to our clients.
o Demonstrate self-motivation and perseverance to achieve goals.
o Role models appropriate, professional behaviors including appropriate client
boundaries.
o Work effectively as part of a team, helping to set up others for success.
EDUCATION:
- High School Diploma or GED required
- Associates degree preferred
Experience:
- Four to six years of experience with insurance billing required
- Previous supervisory experience preferred
Physical Requirements:
- Sitting in a normal position for extended periods of time.
- Reaching by extending hand(s) or arm(s) in any direction.
- Finger dexterity required to manipulate objects with fingers rather than with
whole hand(s) or arm(s), for example, using a keyboard.
- Communication skills using the spoken word.
- Ability to see within normal parameters.
- Ability to hear within normal range.
- Ability to move about.
Certification Required:
- Medical billing and coding certification preferred