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BILLING MANAGER

BRONX, NY, US


The Billing Manager requires the following:

 

Credentialing:

  • New provider credentialing and revalidation for Medicare & Medicaid
  • Make sure that expired documents (Lic, etc.,) are updated with carriers ASAP
  • Ensure new provider(s) onboarded are enrolled correctly with the carrier for all sites
  • Request Security access for provider(s) Load provider into various systems

Finance:

  • Validate/reconcile OR reports against charges billed to ensure charges are not left on billed
  • Occasional manual charge entry, coding review/correction for OR charges to prevent bundling /unbundling
  • Review and correct charges and LCD edits on the hospital side (medical necessity Dx, etc.)
  • Ensure services performed in the various POS meet the CMS guidelines in line with the reimbursement methodologies.
  • Review physicians coding on the PB that fall into various work queue buckets (total of 47 buckets) for all sites and service location (in-patient & out-patient)
  • Review other WQs owned by the hospital for any charges that may have be incorrectly routed for our providers
  • Liaison/work with the AR team daily to appeal claim denials providing letter of medical necessity for case that are erroneously denied for POS conversion
  • Review CDM annually for correct fee schedule when new codes are reported by the physicians
  • Inform providers of missing charges to ensure charges are entered timely
  • Insurance verification coverage
  • Request price quotes for patient without insurance and patients who are from other State or country or self-pay or for cosmetic services
  • Supervise OR schedulers with difficult insurance carriers to pre-auth cases
  • Review denials and educate providers/staff
  • Handle/resolve patients billing complaints, refunds when necessary
  • Deposit co-pay and other incoming AR coverage
  • Monthly numbers reporting for providers
  • Meet with patients who want cosmetic procedures and collect payments (Botox, rhinoplasty, blepharoplasty, etc.)
  • Prepare and reconcile co-pay collections daily
  • Analyze department denials and identify obstacles related to revenue generation and collaborate with individual including leadership to implement solution(s) and best practice related to revenue cycle
  • Educate team on contracting changes when applicable to improve the revenue cycle process

Compliance:

  • Work with the compliance team annually on provider coding and billing compliance chart review
  • Provider one-on-one training in areas where issues are noted and paying close attention to individuals who falls within this area
  • Maintain providers’ compliance training and performance schedule (every 2 years)
  • Schedule new providers for all compliance training courses that are essential to proper documentation, billing, and MMC standards, along with State and CMS guidelines/requirements

Requirements:

Must be a Certified Professional Coder.

Bachelor's Degree Preferred/ HS Diploma Required

 

 

Department: Otorhinolaryngology Bargaining Unit: Non Union Campus: MOSES  Employment Status: Regular Full-Time Address: 3400 Bainbridge Avenue, Bronx
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 159545 

 

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

 

N/A; #LI-AA1 


Mission:
To heal, to teach, to discover and to advance the health of the communities we serve.

Vision:
To be a premier academic medical center that transforms health and enriches lives.

Values
Define our philosophy of care, they shape our actions and motivate and inspire us to pursue excellence and achieve the goals we have set forth for the future. Our values include:

  • Humanity
  • Innovation
  • Teamwork
  • Diversity
  • Equity