Reporting to the Controller, the Biller and Accounts Receivable Supervisor is responsible for timely processing and submission of claims using the electronic health record system (EHRS) and hard copy documents, assuring compliance with all government funding and other health coverages such as, Medi-Cal, Los Angeles County Department of Mental Health contract (LACDMH), SAPC and Other Health Coverage (OHC) Carrier rules. Continuous review of accounts receivable aging and reporting to fiscal senior management.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Oversees the billing functions, including the initiation of goals and procedures, overseeing daily operations, and coordinating billing department efforts to expedite payment of accounts.
- Oversee the timely collection of payments and monitoring of accounts receivable aging.
- Direct billing department staff relations, including supervision, recruiting, interviewing, hiring, orientation, training, staff evaluations, corrective actions, and recommending termination.
- Processes and submits claims to the correct payors in sequence including weekly claims ?gathering' into claims cycles using the Exym/Welligent EHRS, for submission to Other Health Coverage (OHC) Carriers such as Kaiser and Anthem Blue Cross; follows up as needed to ensure claims do not age out, and adhere to the ?90 Day Rule? for submission to Medi-Cal.
- Performs data entry and administration of provider data into the systems required for claiming their services; verifies and administers client eligibility data in support of claims; processes and submits claims and claim explanation of benefit (EOB) response files using Exym/Welligent and paper-based HCFA1500 forms in a timely manner; ensures claims compliance with Medi-Cal, DMH, and OHC Carrier rules.
- Maintains detailed records on submitted claims, claim status, and all status issues that may result in non-payment; reports claim issues to a supervisor with recommendations on follow up.
- Monitors and analyzes claims cycles for any issues, errors, and rule violations before submission; resolve issues and/or reports problems to the supervisor.
- Collaborates with members in Billing, Quality Assurance, Charts, and Records and Finance teams to ensure communication on issues relating to OHC claims, eligibility, and unbilled services.
- Monitors and analyzes claims cycles for any issues, errors, and rule violations before submission; reports claim issues to a supervisor with recommendations for necessarily follow up.
- Monitors/processes claims responses, including monitoring for response files in the secure file transfer web site, such as TA1, 999, 277, 837, and 835 files; downloading and processing these files in the EHRS; reviews 835 response files for accuracy and issues, as well as tracking and reconciling submitted claims to the responses received.
- Verifies client's Medi-Cal eligibility regularly, using an electronic batch method to create and submit files for verification; updates client records accordingly.
- Processes/verifies client Medi-Cal eligibility verification via electronic batches submitted to the state system, including making manual data entry modifications to client pay sources in the EHRS and record updates in the DMH IBHIS system via electronic Client Web Services (CWS) commands; forwards eligibility change communication to appropriate clinical staff and follow up.
- Researches and resolves the claim with issues preventing the claims from being submitted to payors or that resulted in denials, including billing related violations in the EHRS; researches state Medi-Cal and local claim denials; implement the fix or escalates and follows-up with others as necessary.
- Creates, runs, and maintains designated annual and semi-annual corporate reports for program staff (e.g., RBS and Wrap Around program reports); utilizes Exym/Welligent Unbilled report to create the monthly reconciliation data for Summit Meetings that reflects tracking actuals to funding caps.
The incumbent in this position supervises at least two other billing personnel.
- Minimum of two (2) years of previous supervisory billing experience
- Prior experience in Medical billing preferred.
- Must maintain a valid California Drivers' License, have proof of automobile insurance and maintain a safe driving record based on Phoenix House policy
KNOWLEDGE, SKILLS, AND ABILITIES
- Demonstrated commitment and adherence to Phoenix House Mission, Vision, and Values: I CARE For? Integrity, Collaboration Appreciation, Respect, Excellence, and Forward-Thinking.
- Proficiency in MS Office systems.
- Ability to utilize an electronic healthcare record.
- Using mathematics to solve problems.
- Ability to choose the right mathematical methods or formulas to solve a problem.
- Ability to add, subtract, multiply, or divide quickly and correctly.
- Establish and maintain effective working relationships with others.
- Communicate effectively with others both orally and in writing.
- Ability to work effectively in a fast-paced changing environment.
- Ability to model positive behavior and demeanor.
- Excellent time management and organizational skills.
- Ability to be flexible; problem solver, self-directed; customer service-oriented, and collaborative.
Job Location: Lake View Terrace, CA
Job Number: 528