Billing Manager

Join an empowered team that is making a difference in our community!

Are you passionate about Inclusion, and looking for a way to make a difference? Do you have excellent interpersonal skills and the ability to constantly provide top notch customer service? If so, we want to hear from you!

PROVAIL has an exciting opportunity for a Billing Manager to join our team! The Billing Manager is responsible for overseeing the billing operations for PROVAIL's Mobility&. Communication Program, ensuring accurate and timely submission of claims, partnering with Clinic and Accounting staff, and maintaining compliance with State and Federal regulations. The Billing Manager will create and maintain billing policies and procedures, ensure compliance with regulatory requirements, and develop strategies to improve billing efficiency and accuracy.

About Us

PROVAIL was founded in 1942 by parents of children with cerebral palsy. They created some of the first community services for individuals with cerebral palsy and other severe disabilities in the area. Our mission is supporting people with disabilities to fulfill their life choices. We help people decide how they want to live their life in the community and then provide the support services they need to act on those choices. We are one of the state’s largest private, multi-service agencies dedicated to meeting the needs of children and adults with all types of disabilities.

What we offer:

• Competitive pay, $30.29-$32.21 per hour, DOE
• Comprehensive medical, dental, vision insurance with highly subsidized employer contribution for the employee. Dependent coverage for qualified family members is available.
• Employer Funded Health Reimbursement Account (HRA) when enrolled in a medical plan.
• Flexible Spending Accounts (FSA) - Health Care and Dependent Care
• Employee Assistance Program
• 104 hours paid vacation plus incremental increases based on years of service
• Twelve paid personal holidays
• 403(b) retirement plan
• Referral bonus program
• Monthly cell phone stipend and mileage reimbursement
• Extensive paid training and professional development opportunities

ESSENTIAL DUTIES

Billing Operations Management

• Responsible for all aspects of Mobility &. Communication (M&.C) medical billing activities, such as claims, clearinghouse, appeals, accounts receivable, patient statements, & audits
• Responsible for all aspects of M&:C non-medical billing activities, such as private pay contracts and invoices to individuals, businesses, schools, &: government entities including ALTSA, ODHH, DVR, and ODA
• Responsible for the entirety of the Medical Practice Management System (MPMS)
• Approves vendor invoices with proper general ledger codes for accounts payable process
• Utilizes Clearinghouse functions for first-pass denials, insurance-level denials, and claim payment functions, including both ERA and manual paper posting
• Independently able to set up processes & actions for entering non-medical billing activities, including those with zero charges, into the medical practice management system, such as work performed on grants, collaborative projects, and private groups.
• Independently sets up and performs grant billing documents, provider website data-entry, and reconciliation for grant activities
• Works in collaboration with the grant manager, clinical staff, and director to ensure grant reporting submissions are complete, accurate, and timely
• Works in collaboration with clinical staff and director to manage production and time spent on grant work by all M&C parties involved
• Works in collaboration with the PROVAIL accounting department to ensure smooth process, data flow, and reconciliation activities, including creating or modifying policies and processes as needed to improve efficiency and accuracy
• Independently performs and oversees billing reconciliations and month-end process review
• Monitors the schedule and alerts the director of any issues with scheduling, production, high cancel rates, and other preventable scheduling issues
• Prepares and analyzes various reports, identifying trends and areas for improvement
• Extracts and prepares data for department dashboards, metrics, forecasting, and budgeting cycles
• Works in collaboration with and provides support for the Director of Mobility & Communication

Insurance and Authorizations

• Responsible for insurance verifications, benefit checks, and input of relevant insurance information into the client files or MPMS tables with particular attention to coverage based on client age, diagnosis code, concurrent home health, and benefit maximums
• Manages all aspects of initial and ongoing authorizations to ensure continued coverage and payment

Claim Cycle

• Ensures all electronic and paper claims are sent & received by payors timely
• Monitors and manages claims to meet billing requirements per payor, claim type, service type, client age, diagnoses, taxonomy codes, and all relevant modifiers
• Sets up all healthcare payors to deliver processing via ERA where possible; manages, tracks, and works all processing from other sources
• Pulls processing and performs all ERA and manual posting with attention to EFT and/or manual deposit date for smooth reconciliation processes with Accounting
• Performs or ensures all primary processing forwards correctly to secondary or tertiary insurances and that they process in a timely manner
• Coordinates with the Accounting department to set up & ensure payors are set for EFT payment wherever possible
• Coordinates with the Accounting department for manual check payments from non-healthcare payors and performs all manual invoice and private pay posting timely to deposit date

A/R

• Actively tracks and follows up on any unprocessed or unpaid claims, invoices, or statements to keep all primary-processing A/R under 90 days
• Monitors accounts receivable and implements strategies to reduce outstanding balances
• Uses independent judgment to take appropriate actions on processed unpaid claims such as rebilling, insurance issues, appeals, corrected claims write-offs, and adjustments
• Notifies the director in a timely manner of any processing or nonpayment issues, particularly for clients with current ongoing services
• Notifies the director and clinicians of any issues with non-payment due to documentation or non-administrative error
• Facilities the set-up of peer-to-peer and other medical-necessity reviews

Medical Practice Management System (MPMS)

• Independently monitors, updates, and maintains the MPMS such as the dashboard Scheduler, Patient Files, Ledger, Tables, Utilities, EMR modules, etc.
• Works in collaboration with the director and clinical staff to create and/or improve documentation module for greater efficiency and accuracy when charting

Contracts & Credentialing

• Oversees and ensures provider credentialing is initiated, maintained, and up to date. Keeps the MPMS updated with current provider and provider credentialing
• Reviews non-healthcare payor contracts, makes recommendations, and uploads or updates the MPM system in all relevant areas; sets up new or updated documenting, scheduling, charge posting, and billing procedures as needed
• Updates & manages healthcare payor contracts to ensure they are current and active and all compliance with contract is maintained
• Monitors regularly all provider sites for updates to insurance policies such as updates or changes to LCDs, LMN requirements, coverage, and limitations; communicates relevant changes or information to the director and M&C staff as well as takes all necessary actions in the

Compliance & Regulatory Management

• Ensures all billing and documenting activities comply with federal, WA state, and local King County regulations, including HIPAA, DOH, and S. Code of Federal Regulations (CMS Conditions of Participation)
• Sets up and maintains all passwords and access to all provider sites and medical systems, including, but not limited to, Noridian and Provider One.
• Conducts regular audits of the entire MPMS to ensure accuracy and compliance in documenting, billing, & compliance requirements
• Conducts timely audits of the administrative portion of documentation required by Title 42 Subpart H Conditions of Participation
• Works in collaboration with the director and any other member of PROVAIL regarding any and all other regulatory requirements, conditions of participation, and
• Point of contact for all medical audits, certification & re-certifications, and reviews including medical records review & provision, audit tracking & communication, and working with the director on major audit projects and findings
• Tracks, notifies staff, and notifies director of any issues with compliance in all provider-required areas such as licensure, background checks, and trainings such as CPR, handwashing, mandatory reporting, fraud, waste, and abuse, etc.

REQUIRED QUALIFICATIONS

Required Experience:

• Minimum of ten (5) years experience with full revenue cycle medical billing
• Minimum of three (3) years experience full-cycle billing for outpatient occupational, speech, physical, and neurodevelopmental therapy
  • Experience with Telehealth billing for Washington State outpatient therapies preferred
  • Experience with ABA/Mental Health / Counseling I Psychology/ Neuropsychology / sensory-feeding billing desired
• Minimum of three (3) years experience updating, maintaining, and creating content or new modules for Medical Practice Management systems, including tables, ledgers, billing, posting, scheduling, and EMR
  • Experience with Raintree medical practice management system preferred
• Minimum of three (3) years experience with full-cycle billing for both pediatric and adult populations
  • Deep understanding of the intricacies of the differing requirements based on client age, diagnosis code, service type, and insurance plan type preferred
• Experience with Jurisdiction F Noridian Medicare, Medicare Replacement and Dual-complete plans, Washington State Medicaid, Apple Health ACA, and Medicaid managed-care plans.

Required Skills:

• Good judgment and the ability to recognize when to take initiative and when consultation is
• Thorough and accurate attention to
• Proven ability to meet strict deadlines, particularly month-end close, timely filing, medical record responses, and other critical deadlines.
• Ability to analyze patient ledgers, medical claim ft clearinghouse data, scheduling reports, dashboard data, as well as various custom and standard reports and data to make informed decisions and recommendations

PROVAIL is committed to diversity & inclusion and continually working to build an organizational culture and climate in which every voice is valued, staff have a sense of belonging and connection with one another and to the organization, and staff feel empowered to do their best work. We specifically encourage people of color, individuals who identify as LGBTQ and individuals with disabilities to apply for this position.

PROVAIL is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by law.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.