BILLING &REIMBURSEMENT MANAGER-FT bei Memorial Regional Health

ESSENTIAL FUNCTIONS AND BASIC DUTIES:
Supervisory-Specific Performance Expectations, Duties, and Responsibilities:
o Demonstrates 100% commitment to high perfonnance in accordance with the CHOICE values ofMRH and
represents the organization in a positive and professional manner.
o Provide direct supervision to the billing staff, ensuring perfonnance expectations are met,
including training and onboarding of new staff to ensure proficiency in the billing processes.
o Foster a collaborative and accountable work environment.
o Conduct regular staff meetings to communication updates, policies, and goals.
o Develop training programs to ensure staff remains current on billing regulations, payer
policies, and claim submission best practices.
o Conduct employe evaluations, bi-weekly timesheet approvals, and attend monthly management
meetings.
Position-Specific Performance Expectations, Duties, and Responsibilities:
o Oversee the accurate and timely submission of claims for inpatient, outpatient, and professional
services.
o Ensure compliance with healthcare regulations, including HIPPA, CMS guidelines, and other
relevant laws and standards.
o Stay updated on changes in healthcare regulations and payer requirements that impact the revenue
cycle.
o Analyze denials, implement corrective actions, and oversee the appeals process to maximize
reimbursement.
o Review and correct claim edits to ensure compliance with payer regulations while minimizing
denials and billing errors.
o Collaborate with departments such as Registration, Coding, and Finance to develop and implement
process improvements.
o Ensure timely management of old and/or uncollectible accounts including bad debt with regular
reviews, appropriate write-offs, and implementation of strategies to minimize future occurrences.
o Member of the RAC team. Must have a general understanding of the RAC program. The team
establishes proc< and procedures to manage audits and verify compliance. Work closely with the
Compliance Officer on Revenue Cycle related issues as requested.
o Conducts internal audits pertaining to work queue management. Review and evaluate results. Make
recommendations based on these results to improve revenue, workflows and/or compliance regulations.
o Identify opportunities to optimize revenue capture and minimize revenue leakage.

o Conduct and review audits on current denials to detennine root causes and identify patterns or
trends.
o Provide monthly detailed reporting statistics to the Revenue Cycle Director and CFO on K.Pls.
o Demonstrates a professional, positive and caring attitude. .,.
o Works closely with other departments, including, but not limited to registration, prior
authorization, and coding.
o Performs other duties as assigned.

Organization-Specific Performance Expectations, Duties, and Responsibilities:
o Demonstrates 100% commitment to performance in accordance with the CHOICE values ofMRH and
representing the organization in a positive and professional manner.
o Establishes and maintains effective verbal and written communication and good working
relationships with all patients, staff, and vendors.
o Adheres to MRH attire/dress code per policies and procedures.
o Utilizes initiative; strives to maintain a steady level of productivity; self-motivated; and
manages activity and time.
o Completes annual education, training, in-service, and licensure/certification requirements; and
attends departmental and organizational staff meetings or reads meeting minutes.
o Maintains patient confidentiality at all times.
o Reports to work on time as scheduled; completes work within designated timeframes.
o Actively participates in departmental and organizational performance improvement and continuous
quality improvement activities.
o Strives to uphold regulatory requirements to ensure continual compliance with departmental,
hospital, state, and federal regulations and policies.
o Follows policies and procedures for infection control, safety, and risk management to ensure a
safe environment for patients, the public, and staff.

[QUALIFICATIONS:
Minimum Requirements:
o Must be at least 16 years ofage (21 for driving positions with a valid driver's license).
o Must be able to legally work in the United States.
o Must be able to pass a background check.
o Must be able to pass a drug screen and breath alcohol test (if applicable).
o Must complete employee health meeting.
o Excellent analytical, organizational, and communication skills.
o Extensive knowledge in CAH and RHC billing and coding practices.

Required Education/Licensure/Certification:
o Bachelor's Degree in Healthcare Administration, Finance, Accounting, or a related field
required.
o Minimum of 5 years of experience in healthcare revenue cycle auditing, billing, coding, or
related field required.
o Proficiency in Microsoft Excel required.
o Minimum of2 years of experience in a Critical Access Hospital and Rural Health Clinic Revenue
Cycle role.
o Strong leadership, problem-solving, and communication skills with the ability to manage a team
effectively required.
Experience:
o Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent
certification preferred.
o Proficiency in EPIC preferred.
o Strong understanding of UB-04 and CMS-1500 claim forms required.

Position Classification:  Non-Exempt

Compensation Range: $41.86 to $62.78

Benefits:  Medical, Dental, Life, Retirement, Paid Time Off

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Revised 03/05/2025

APTITUDES

IDGH

MED

LOW

SPECIAL CONSIDERATIONS

Visual Requirements        X

Auditory Requirements      X

Hand Dexterity           X

Mobility:      Full Body   X Partial Body   X

Coordination:    Eve/Hand   X

Eve/Foot   X

Critical Thinking          X

Must be able to communicate with all employees clearly and effectively.

Typing required.

Mobility throughout the hospital.

PHYSICAL DEMAND

STANDING SITTING WALKING STRENGTH

CARRYING I LIFTING LESS THAN 10#

11-25#

26-50#

51-75#

76-100#

More than 100# CLIMBS/ BALANCES KNEELING CRAWLING STOOP/BEND REACH I HANDLE PULLING/ PUSHING 

DRIVING/ RIDING

Rarely 1-10%

X X X X X X X X

X

X

Occasionally 11-33%

X

X X X

X

Frequently 34-66%

X

X

Continuous 67-100%

X

BIOHAZARDS:

Category I:

  Category II:

X  Category III:

Tasks that involve exposure to blood, body fluids, and/or tissues are required.

Tasks that involve no exposure to blood, body fluids, or tissues, but employment may require 

performing unplanned Category I Tasks.

Not working with blood, body fluids, or tissues.