Top reasons to work for SMA Healthcare:

• Career growth and advancement potential
• Great benefits such as: Health, Dental, Vision, Life, & Disability Insurance
• Tuition Reimbursement
• Paid Personal Leave and Paid Holidays
• 403b Retirement Plan (matches one to one of employee contribution for the first 3%, then a 50% match on the next 6% of employee contribution)

Supervisory Responsibility:  Ensures that the selection of employees and any subsequent personnel actions are administered without regard to race, religion, color, veteran's status, national origin, citizenship, sex, age, or non-job-related disability and consistent with Affirmative Action objectives and EEO laws.

Essential Job Functions:   

• Oversee and support the daily operations including billing, follow-up and collections.
• Work closely with other departments to streamline procedures that will help ensure correct billing to clients and payers in a timely manner, thereby expediting healthcare receivables
• Oversee work schedule and direct changes in priorities and schedules as needed to assure work is completed in an efficient and timely manner and to improve the department's performance and service.
• Monitor team performance, making changes, when required, to support accurate billing in a timely manner and compliance with laws and department procedures.
• Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the Chief Financial Officer.
• Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters.
• Maintain extensive knowledge of revenue cycle and regulatory requirements.
• Serve as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implementing solutions.
• Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
• Responsible for maximizing the collection of medical services payments and reimbursements from clients, insurance carriers, financial aid, and guarantors.
• In conjunction with operations, reviews and enhances insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow.
• Analyzes claims, utilization, and medical cost data.
• Reviews, monitors and recommends updates to the fee schedule to maintain fees at levels that maximize reimbursement.
• Ensures compliance with relevant federal, state, and payor-specific billing requirements.
• Regularly provides upper management with revenue cycle status including reports, metrics, and presentation.
• Makes commitment to SMA's mission and core values the SMA Way
• Abides by principles of EEO compliance and a workplace of dignity and respect.
• Works cooperatively in a group/team setting.
• Shows respect to others.
• Takes guidance and direction from supervisors.
• Arrives/Reports to work on time and ready to work.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education and/or Experience:  Bachelor's degree in Healthcare Administration, Business, Accounting, Finance or related field and three years of management-level experience in healthcare revenue cycle with expertise in billing and collections.

Knowledge/Skills/and Abilities: 

• Thorough knowledge of processes and standards related to billing, collections, and cash posting. General knowledge of client registration, finance, and data processing.
• Knowledge of regulatory requirements related to client accounting, including a solid understanding of Medicare, Medicaid and managed care processes.
• Knowledge and experience related to Utilization Review process.
• Ability to work and communicate effectively with a diverse group of people including other department managers, staff, physicians, clients, and the public.
• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.
• Outstanding ability to work independently to achieve results. Must originate, plan, adapt and invent to accomplish tasks.
• Ability to set and maintain priorities when dealing with multiple demands and interruptions.
• Strong analytical and problem-solving skills.
• Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.
• Excellent customer service skills.
• Intermediate computer skills including email, word processing, spreadsheets, and working with graphics.

Necessary Special Requirements: Possession of a valid Florida driver's license and acceptable driving record if required to drive SMA vehicle and/or use personal vehicle for SMA business. Proof of personal automobile insurance if the position requires you to drive your own vehicle for SMA business (does not include incidental use). Complete State of Florida mandatory level 2 background screening  prior to start of employment if direct contact with children/adolescents, vulnerable adults, or the developmentally disabled may be involved.  Complete Mandt training, CPR, First Aid and HIV/AIDS training during the first six (6) months of employment and updated if required.

Physical: Mobility and ability to bend and reach during an 8-12 hour day. Able to lift minimum 10 pounds. Visual and auditory acuity sufficient to evaluate, intervene, treat, and record client health care needs. Fine motor skills for legible and accurate charting, daily correspondence and presentation, either manually or orally. Work endurance ability to work 8-12 hour shifts with a meal break, as possible. Routine 8-12  hour shifts. Hours and days off may vary. Extra hours may be required. Work assignment locations may vary.

Application: This class specification is intended to identify the class and illustrate the kinds of duties that may be assigned to its incumbents.  It should not be interpreted as describing all of the duties whose performance may ever be required of such an employee or be used to limit the nature and extent of assignments such individuals may be given.