Job Details

We are seeking a highly organized and experienced Medical Office Manager to oversee the daily operations of a busy pediatric clinic. Previous medical office management required.

The candidate must be able to evaluate current practices and offer ideas to make the practice run more efficiently.  You will be valued here and we will look to you for ideas from day one.  We seek excellence in all aspects of our practice.  

Benefits include competitive salary, health insurance, and retirement plan.  After an initial period, your salary could increase based on the improvements in profitability attributable to your contributions and innovations.  

Responsibilities

• Revenue Cycle Management Responsibilities:
• Insurance Verification and Authorization:
• Ensure accurate verification of patient insurance eligibility and benefits.
• Obtain pre-authorizations and referrals for services as required by insurance plans.
• Patient Registration and Data Entry:
• Oversee the collection and accurate input of patient demographic and insurance information into the EHR system.
• Ensure proper documentation of guarantor information and assignment of benefits.
• Billing and Coding:
• Interface with an outside billing company to optimize claims submission
• Stay updated on coding guidelines and pediatric-specific billing changes.
• Claims Management:
• Track claims to ensure timely processing by payers.
• Follow up on denied or rejected claims
• Work with insurance companies to resolve outstanding claim issues.
• Follow up with patients about outstanding claims and balances
• Accounts Receivable Management:
• Monitor accounts receivable (AR) aging reports and take action on overdue accounts.
• Develop and implement strategies to reduce AR days.
• Manage patient payment plans and financial counseling when needed.
• Collections:
• Ensure timely collection of copays, deductibles, and coinsurance at the time of service.
• Manage outstanding patient balances and send reminders or statements.
• Oversee third-party collection agencies for unresolved balances, if applicable.
• Payment Posting and Reconciliation:
• Supervise staff responsible for posting insurance and patient payments.
• Reconcile daily receipts, deposits, and credit card transactions.
• Ensure the accuracy of adjustments, write-offs, and refunds.
• Financial Reporting and Analysis:
• Analyze revenue cycle performance and identify areas for improvement.
• Compliance and Audit:
• Ensure adherence to HIPAA regulations and protect patient data confidentiality.
• Maintain up-to-date knowledge of Medicaid, CHIP, and commercial insurance policies relevant to pediatric care. In particular be familiar with nuances and reimbursement rates for local insurance carriers as well as larger insurance carriers.
• Staff Training and Supervision:
• Train and mentor front-desk staff on RCM processes, insurance policies, and software usage.
• Patient Communication:
• Address patient inquiries related to billing, insurance, and financial obligations.
• Handle disputes or escalations regarding billing issues professionally and empathetically.
• Technology and Vendor Management:
• Oversee the implementation and maintenance of billing software and EHR systems.
• Manage relationships with third-party billing services, clearinghouses, and collection agencies.
• Policy Development and Implementation:
• Develop and enforce billing and collections policies to ensure consistency and compliance.
• Create workflows to streamline revenue cycle processes and reduce errors.
• Quality Improvement:
• Continuously monitor and improve RCM workflows to maximize revenue and efficiency.
• Stay updated on pediatric billing best practices and integrate them into the practice.
• Revenue Optimization:
• Identify opportunities for increasing revenue, such as negotiating payer contracts or exploring new billing opportunities.
• Ensure timely enrollment and credentialing of providers with insurance payers.
• Ensure timely enrollment of patients with insurance payers.
• Cost-Saving Responsibilities:
• Supplier Negotiation:
• Negotiate contracts with vendors for medical equipment, testing supplies, and vaccines to secure bulk discounts and favorable terms.
• Compare pricing and terms across multiple suppliers to ensure the best value.
• Build long-term relationships with reliable vendors for consistent quality and cost savings.
• Inventory Monitoring:
• Implement and maintain an inventory management system to track usage of medical equipment, testing supplies, and vaccines.
• Set reorder thresholds to avoid overstocking or understocking, reducing waste and ensuring availability.
• Immunization Management
• Manage the VFC program and interface with the representative from the Mississippi Department of Health 
• Recommend the best vaccine regimen from the various vendor portfolios 
• Usage Analysis:
• Monitor patterns in supply usage and identify areas where consumption can be reduced without compromising patient care.
• Collaborate with clinical staff to minimize overuse or improper use of supplies.
• Act as a Medical Receptionist when needed. Everyone here answers the phone and has the first opportunity to ensure a good experience for the patient.
• Efficiently manage patient interactions and train other staff members to do the same.

Qualifications

• Proven experience in medical office management and practice management
• Experience in budgeting and fiscal management within a medical setting
• Supervisory experience and familiarity with human resources practices