General Description

Under the direction of the Chief Financial Officer and within federal, state, and local guidelines performs advanced reimbursement or claims processing work. Work involves coordinating and monitoring billing and collection activities.

The Billing Director is responsible for designing and implementing the billing procedures for the Center. This position advises and assists with activities associated with collections and managing the accounts receivables and in doing so adheres to all applicable laws, regulations, policies, and procedures of DCMHMR and the funding agencies thereof. It is also responsible for monthly Medicaid billing, processing electronic payments, preparing Excel reports and special projects. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.

Education, Training and Experience (including licensure and certification)

• Bachelor's degree in accounting or related field required. Education can be substituted with experience on a year-for-year basis.
• Experience with Medicare and/or Medicaid reimbursement is highly preferred. Must be proficient in Microsoft Excel and Word and be familiar with SQL.

REGISTRATION, CERTIFICATION, LICENSURE OR OTHER QUALIFICATIONS:

• Possession of a valid driver's license and current automobile insurance.

• Successful completion of all position-specific training within thirty (30) days of employment is required.

Knowledge, Skills, and Abilities

• Knowledge of the principles of collection and accounting, and of the rules and regulations governing reimbursement for agency services.
• Skill in resolving problems, reviewing, and evaluating options, implementing solutions, using general office equipment and computers, and interview techniques.
• Ability to communicate effectively orally and in writing, and to plan, assign, and/or supervise the work of others.
• Understanding and practice of Trauma Informed Care principles.

Essential Duties

Below is a list of essential duties of the position. Other duties may be assigned as needed.

1. Ensures that billing system reconciles to the general ledger.

Performs all month end closing functions in the billing system.

Provide monthly reports of receivables.

Provide recommendations for accounts that need to be written off.

Monitors the Accounts Receivable Aging to assure timeliness of claim resolution.

1. Cash posted by billing team in accounts receivable matches related funds received.
2. Monthly reports are provided within a reasonable time frame after month end close is completed.
3. Reviews reports and makes recommendations to resolve collection reporting issues as needed.

1. Establish and maintain a set of procedures that can ensure system integrity. Make changes as rules and programs change.
   • Ensure event rule database is updated and appropriate.
2. Advise staff of changes in laws and regulating services.
3. Ensure rates are updated and correct.
4. Ensure Funding Source file, Contract file and Chart of Accounts for billing are updated and appropriate.
5. Manage MBOW report for Billing, consumer eligibility and Encounter Data.
   1. Learn and understand the regulatory and billing changes upcoming.
6. Communicate changes and their potential impact from a billing and collections perspective.

1. Oversees the processing of all MH and IDD claims including, but not limited to, Medicaid, Medicare, third party insurance and private pay claims.
   • Oversees billing helpdesk for all center users with regard to service activity codes and BUI notes entry and validation questions for all programs.
     1. Establish guidelines for timelines for submitting, posting, and appealing claims.
   • Actively monitor and assess success in submitting, posting and appealing claims.
   • Reports are provided that demonstrate claims success by payer.

1. Oversees electronic payments and the preparation of Excel reports on payments and denials of claims by various funding sources for all Mental Health and Intellectual Disability claims.
   • Assists with special projects related to data collection, data entry, billing, and collections feels.
2. Will provide reports for internal auditors as requested.
3. Denials reports are created and distributed.
4. Interprets report requests and is able to produce reports within a reasonable time period based on the priority of the request.

Supervisory Tasks & Standards

Positions are posted and filled in compliance with Center procedures and timelines.

• The supervisor will provide individual written supervision to the staff supervised by the position, as needed. Supervision will provide guidance for outstanding needs of staff and contractors. (i.e. Review documentation for accuracy and content or provide input) Supervisor will effectively communicate with staff the information that is needed for supervisors to effectively manage their teams and programs.

Positions are posted and filled timely.

Newly hired staff receive supervisions from month of hire through sixth month of employment.

Any staff having difficulties in performing their duties are receiving adequate supervision.

Performance Evaluations must be completed within required timeframes and provide accurate depiction on employee's performance and outline goals for improvement if needed.

• No delinquent staff evaluations.

Ensures employees comply with education and training requirements, 100% compliance.

Ensures that employees are trained to perform their jobs and that various requirements of the position are communicated to the employee.

Supervisor will address performance issues and ensure that the staff is operating within acceptable Center guidelines.

• All subordinates staff are current in all trainings.
• All performance and/or attendance issues are addressed immediately.