Lead Billing Manager

Job Overview

The lead billing manager is responsible for ensuring the timely and accurate submission, reconciliation, and processing of billing and service data in compliance with Los Angeles County Dept. of Mental Health and SUD contractual and licensing requirements, policies and procedures.

Key Responsibilities

  • Full oversight and responsibility for DMH billing operations, processing, and procedures.
  • Assist in and oversee LA SAPC and other non-DMH SUD billing operations for HealthRIGHT 360 in Southern California region.
  • Consistent and efficient processing of eligibility checks, auditing, denial corrections, claims submission (voids, rebills, writeoffs and OHC) and collection.
  • Regular review and reconciliation of claims to prevent claim aging.
  • Works collaboratively with Finance department for timely completion and submission of Cost Reports to LACDMH.
  • Monthly monitoring and reporting of productivity, billed claims, denied claims, unbillable claims, write offs, plan usage and reconciliation between Welligent system and Electronic File Transfer (EFT) data.
  • Collaborate with members of Quality Improvement (QI), Medical Records and Finance teams to ensure communication on issues relating to DMH billing and contract compliance. Collaborate with program supervisors about quality assurance issues reviewed by billing staff. Provide feedback on areas of strengths and areas of improvement and audit risk. Reports billing compliance, timelines and scope of practice issues on Quality Assurance reports as required (frequency TBD).
  • Communicates and cooperates with HR360 IT EHR management around all Welligent technical and maintenance issues.
  • Oversees organization of financial records for visits and audits; prepares audit reports as needed in collaboration with Finance (TBD)
  • Researches information for compliance with local, state, and federal regulations as needed and directed.
  • Maintains documentation of billing activities; collaborates with other area agencies as needed.
  • Maintains working knowledge of contracts, internal program standards and policies, DMH and other governing bodies; develops personal and professional knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the art practices, and participating in agency trainings.
  • Recommends and assists in writing policies and procedures to facilitate communication and timely information flow to improve quality assurance and compliance issues.
  •  Ensures all cross-training of staff in DMH billing systems. Ensures training guides are maintained for training new staff and cross-training purposes.
  • Ensure all DMH billing staff complies with the legal mandates of HIPAA for client confidentiality and release of information.
  • Assesses and analyzes deficiencies in client billable progress notes and identifies trends in deficiencies, develops and assists Quaility Assurance and Program Directors in implementing corrective action measures and methods for improving the maintenance of clinical records.
  • Ensures staff participation in meetings sponsored by DMH; informs appropriate agency personnel regarding updates and issues; assists director in implementation of new standards, timelines or changes to DMH contract.
  • Acts as a contact for DMH personnel relative to financial audits.
  • Performs supervisory duties including: recruitment, interviewing, hiring, training, develop and evaluating department staff; manages performance, conducts performance appraisals and recommends salary increases; takes disciplinary measures as needed.
  • Develops and maintains effective working relationships with other agency departments to coordinate services and functions as needed.
  •  Incorporates agency philosophy and mission in all aspects of job performance.
  • Attends/Leads and participates in department staff, and support meetings, and in-service programs, and agency meetings as appropriate.
  • Maintains confidentiality regarding clients, families and operations of the agency.
  • Exercises good judgment in the performance of duties and responsibilities.

Education and Knowledge, Skills and Abilities

  • BA or BS
  • High degree of accuracy, speed, and attention to detail.
  • Firm grasp of Los Angeles County Dept. of Mental Health billing compliance and regulatory requirements.< > knowledge of LACDMH IBHIS system.
  • Understanding of Medi-Cal and OHC billing processes and procedures.
  • Ability to prioritize and multitask.
  • Strong Microsoft Excel, Word, and Outlook skills.
  • Good interpersonal skills and ability to work as a team player.
  • Strong problem solving skills, is self-directed and able to test and resolve issues with minimal input from management.
  • Ability to supervise and direct billing staff in required duties and responsibilities.
  • Skill in process and procedure development to support position duties and operations.
  • Ability to communicate clearly and succinctly in a variety of situations and mediums, including groups, one-on-one, email, and phone.
  • Ability to work efficiently and productively in an independent manner.
  • Strong understanding of basic PC and common office productivity software.
  • Desire to learn and eagerness to elevate the efficiency of the department and agency as a whole.

Desired Skills, Knowledge and Education:

  • Previous familiarity with non-profit behavioral/mental healthcare operations and landscape.
  • Experience using an electronic health record system--Welligent in specific.
Compensation: $60,000.00-$75,000.00
Type: Salary/ Exempt
Benefits: Plus HealthRIGHT 360 offers a comprehensive benefit package!
City: Pasadena, CA
Hours/wk: 40

Job Location