TOMAGWA Ministries, Inc. FQHC Billing and Coding Manager Tomball, TX · Full time

Focusing TOMAGWA’s resources and efforts to increase claim reimbursement by developing the necessary departments and their role within Revenue Cycle.

Description

Job Title: Billing Manager

Department: Finance

Reports To: Finance Director

FLSA Status: Exempt

Location: Tomball, Texas


Qualifications:

- Five years of current experience in healthcare billing and coding (CPT, ICD-10, & HCPCS) required.

- Intermediate to advanced proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook) required.

- Advanced proficiency with spreadsheet creation, manipulation, and reporting preferred.

- 1-2 years of experience with FQHC & IHS clinical billing required.

- 2 years of supervisory experience required.

- Ability to train staff and set performance expectations.

- Exceptional interpersonal verbal and written communication skills; consultation and mediation skills; organizational skills; high accuracy, flexibility, ability to multi-task, and prioritize effectively in a team environment.

- Ability to maintain professional boundaries with clients, the community, and other staff members.

- Work collaboratively with clients, other TMI staff, team members, and to treat everyone with respect and dignity at all times.

- Analytical and Problem-Solving Skills: Medical billing often involves complex problem-solving.

- Analyze billing discrepancies, identify root causes, and implement effective solutions.

- Attention to detail, precision, and billing accuracy.

- Knowledge of FQHC billing and coding (Medicare G codes, Medicaid modifiers, etc.).

- Experience in FQHC payers and navigating program-specific regulations, enrollment, and procedures.

- Communication skills: It is important for a team member to be able to communicate and provide billing training to staff and providers.

- Communication with each of these often requires different skills to solve problems and answer questions.


Education/Experience:

- Required Credentials (must have one of the following):

o American Academy of Professional Coders (AAPC)

o American Health Information Management Association (AHIMA)


Duties and Responsibilities:

- Manage, direct, and monitor billing and reimbursement activities; ensure accurate billing to the appropriate third party.

- Manage Billing Specialists; distribute and audit work, maintain a customer service focus across the department.

- Review patient account status; submit electronic and paper claims to carriers for reimbursement; identify research and resolve billing and submission errors.

- Post payments and denials; enter charges for encounters; monitor client co-pays and premiums; research and resolve denials.

- Generate periodic and ad hoc reports; communicate regarding AR variations, changes in billing and reimbursement status.

- Set up new providers in practice management system and coordinate with Credentialing Specialist and hiring managers on the set-up. Coordinate with Coding Manager on onboarding new providers and expectations regarding billing.

- Assist in planning and directing registration, patient insurance, billing and collections, and data processing to ensure accurate patient billing and efficient account collection.

- Coordinate with Front Office leads and Practice Managers to train receptionists on insurances, sliding fee scale, and other billing information to ensure clean claims.

- Collaborate with Billing Operations Director and IT regarding set-up changes and system updates within practice management database.

- Contribute to the implementation of new components in the practice management system and the implementation of an Electronic Health Record system.

- Assist Billing Operations Director in monitoring the practice management system, provide feedback and billing training to intake and front desk staff; collaborate to monitor productivity.

- Facilitate regular billing meetings. Filing of all primary and secondary claims electronically

- Handle all insurance appeals and follow up.

- Manage payment posting and EOB review.

- Prepare daily/monthly management reports as defined by management.

- Create and audit charges: includes verifying insurance prior to submitting claim, auditing for correct codes and modifiers per each insurance requirement

- Manage rejections from clearinghouse.

- Post payments from all insurance companies.

- Handle all denials and appeal all claims.

- Answer all patient questions regarding billing.