Outreach is a non-profit organization that helps people address the issues stemming from substance use and behavioral health disorders by providing the highest quality, life-changing treatment, training, and tools to build healthy lives . Our mission is to inspire individuals and families to achieve a life of unlimited potential by developing and delivering the highest quality evidence-based behavioral health services and training. For more information, please visit www.opiny.org.

Position: Residential Billing Manager

The position reports to the Assistant Vice President of Residential Services. The position will also work closely with the central billing office and be a go between them and the programs. It manages, monitors, and ensures the execution of the billing and collections for all services rendered by the residential programs.

The position is responsible for making sure that services rendered are billed correctly, fees are established and applied on a consistent as well as equitable basis, accurate records are maintained, bills are processed and collected expeditiously, and reports are produced on a timely basis showing status of processed and pending bills.

The position is co-responsible for the supervision of all the full and part-time client billing associates in the residential programs.

Job Scope

Documentation & Verification

Coordinates with the affected staff to make sure that the following tasks are performed.

• Obtains authorization/pre-certification for new clients’ treatment.

• Verifies client’s insurance before admission and as needed during the treatment episode.

• Performs day to day financial transactions including verifying, classifying, computing, posting, and recording accounts receivable data.

• Tracks clients’ authorized visits.

• Matches billing accounts with accounts receivable ledger to ensure that all payments are accounted for and properly posted.

• Notifies unit secretaries/support staff of any change in client’s Medicaid/Child Health Plus or insurance benefit status.

• Interacts with counseling staff/supervisors to obtain information required for authorization of services and/or to ensure that appropriate calls are made by counseling staff to obtain authorization. Distribute insurance treatment plan to counselors for clients’ ongoing treatment authorization.

• Stays current on regulatory changes related to Medicaid, Child Health Plus and other that impact billing...addresses these changes within the billing system and with affected staff/managers.

Establishing Fees

• Implements written procedures to ensure consistency in establishing fees as well as collecting them.

• Provides guidance to other staff involved in establishing and collecting fees.

• Receives financial information from the intake worker for a new client...based on insurance and salary data assigns the client a fee utilizing the "discounted daily rate fee schedule" and confirms that the client accepts fee so that admission can be scheduled.

• Work with low-income families in applying for Medicaid or Child Health Plus, assists them with the preparation of the Medicaid/Child Health Plus application, liaisons with appropriate contact personnel in expediting process.

Billing

• Responsible for billing all self-pay clients as well as for billing the self-pay portion of clients covered by commercial insurance.

• Ensures that central billing & collections prepares and submits Medicaid claims/Child Health Plus as well as third party insurance claims monthly or on a more frequent basis, as appropriate.

• Faxes required documentation including information related to the level of care determination and/or treatment plan, as appropriate, to insurance companies.

• Removes client from Medicaid/Child Health Plus within 48 hours of a client’s discharge.

Collection, Tracking & Reporting

• Processes accounts and incoming payments in compliance with financial policies and procedures.

• Notifies counselors of any requests the insurance company has for information.

• Follows up with counselors to ensure completion of any re-certification for additional visits.

• Generates reports from billing system detailing accounts receivable status and distributes to Directors.

• Troubleshoots any billing/payment problems.

• Collects family fees from the parents/guardians during Parent Support Group evenings.

• Meets with clients, significant others, or guardians.to ensure payments are up to date and, if necessary, discuss any financial situations that need to be addressed.

• Works with central billing to bill insurance, collect and document payments and follow up on denials.

Public Assistance

• Ensure all public assistance application are completed within 72 hours of a client’s admission to Outreach.

• Ensure Removes client from Public Assistance case within 72 hours of a client’s discharge.

• Ensure that clients PNA money received monthly and after they have been discharged from Outreach.

• Functions as a liaison between Outreach and county, state, or other public assistance programs.

• Ensure effective monitoring of public assistance for all clients whose application has been accepted.

• Troubleshoot any billing/payment problems that are occurring with public assistance organizations.

• Ensure timely collection of fees from the clients, significant others, or guardians.

• Adjusts daily rate as needed as it relates to changes in reimbursement from the public assistance and income due to clients working.

Supervision

• Provides billing related supervision to all client billing associates.

• Provide training to all client billing associates on residential billing related reasonability’s.

• Work with residential program directors on administrative supervision of client billing associates.

• Co-facilitates yearly evaluation process with residential program directors.

Other

• Perform other tasks assigned (on an as needed basis) by the supervisor.

  Qualifications

• Prior Medical Billing experience is required.

• Knowledge of Medicaid, Child Health Plus and other benefits programs directed at low-income households desirable.

• Strong problem-solving skills.

• Personal drive, action-oriented, quick learner.

• Ability to thrive in a busy, fast-paced team environment as well as work independently.

• Adept in Microsoft Office Outlook, Word, and Excel.

• Strong communication and people skills.

  Work Environment

  This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Must have ability to travel among assigned sites as needed. There may be long periods of standing, sitting, and computer usage.