Job Description

Overview Accounts Receivable and Medical Billing Manager job at Wingspan Care Group. Cleveland, OH. Agency Summary: Wingspan Care Group is a nonprofit administrative and management organization that provides a united, community-based network of services so member agencies can focus on mission-related goals. Our model promotes sustainability and advancement among partner agencies by streamlining operations and eliminating redundancies to improve direct service delivery. Responsibilities Responsibilities Include: Billing and Claim Management: Oversee the end-to-end medical billing process, including claim submission, follow-up, and payment posting for ~130,000 claims/year (95%+ Medicaid/MCO/Aetna OhioRISE). Ensure accurate and timely submission of claims through clearinghouses, adhering to payer-specific guidelines (e.g., Ohio Medicaid, Aetna OhioRISE, Commercial). Utilize billing software (Netsmart) to streamline claim processing and monitor submission status. Accounts Receivable Management: Monitor and reduce outstanding balances targeting AR days Develop and implement strategies to resolve aged AR. Maintain accurate aging reports, identifying accounts for potential write-offs or other adjustments. Denial Management and Appeals: Oversee denial management processes, ensuring timely appeals, targeting Analyze denial trends (e.g., coding errors, authorization issues) and collaborate with Denial Management Specialist and Director of Revenue Cycle to implement preventive measures. Ensure proper handling of Explanation of Benefits (EOBs), Single Case Agreements (SCAs), and Letters of Agreement (LOAs). Staff Supervision and Training: Supervise a team, including AR Specialists, Denial Management Specialists, and Cash Application Specialists, including hiring, training, performance appraisals, and disciplinary actions. Develop and conduct subject matter training on billing, denials, and payer policies (e.g., Medicaid, Aetna OhioRISE), ensuring cross-training for coverage (e.g., vacations). Document workflows and policies to set consistent expectations, supporting new hires and process standardization. Establishes a training manual for existing and new employees to create consistent workflows and standards of performance. Revenue Cycle Optimization: Identify and implement strategies to improve revenue cycle efficiency, reduce unbilled claims, and enhance cash flow. Coordinate with clinical staff to ensure proper documentation, eligibility, and licensure for accurate billing. Assist in month-end close processes, including AR-to-General Ledger reconciliations. Support AR Specialists, Denial Management Specialist, Cash Application Specialist, and AR Support Specialist during high volume and vacancy coverage as needed. Insurance and Payer Relations: Communicate with payers (Medicaid, MCOs, Aetna OhioRISE, commercial) via phone, email, or portals to resolve payment delays, verify benefits, and monitor payments against contracts. Follow up on escalated accounts, processing additional documentation requests and resolving outstanding balances. Stay updated on payer policies, Ohio Medicaid regulations, and behavioral health billing rules to ensure compliance. Follow coding guidelines and payer-specific rules to ensure accurate and ethical coding. Stay current with changes in CMS, AMA, and payer policies. Reporting and Analysis: Prepare and analyze financial reports (e.g., aging, denial, and collection reports), providing insights to the Director of Revenue Cycle, CFO, Executive Directors, and Practice Managers/Supervisors. Conduct weekly aging report reviews with team leads and meet weekly with the Director of Revenue Cycle to discuss AR status and write-off candidates. Maintain detailed notes on communications with payers, departments, and escalated accounts for continued follow-up and audit readiness. Compliance and Audit Support: Ensure compliance with HIPAA, Ohio Medicaid regulations, and other federal/state laws, maintaining confidentiality of client data. Prepare for and support external audits and accreditation reviews, coordinating with internal leadership as needed or directly with auditors if required. Update and enforce financial policies aligned with company and industry standards. Stakeholder Communication (Agency Leadership): Work with Agency directors to answer AR related questions from Operating Statements using GL and monthly billings as a guide. Monitor and work inquiries into the AR Errors mailbox, responding within 1 business day of receipt and regularly communicating on status of errors as needed. Collaborate with clinical, administrative, and accounting teams to resolve credentialing, contract, or billing issues. Technology and Process Improvement: Leverage billing software (Netsmart), clearinghouses, and payer portals, to automate processes (e.g., 835 posting). Identify process improvement opportunities, implementing best practices to enhance workflow and productivity. Conduct bi-weekly department meetings to discuss trends, payer issues, and training needs. Report at the monthly Revenue Cycle Committee Qualifications Qualifications: Bachelor\'s degree in business administration, finance, accounting, healthcare, or related field preferred; or Associate\'s degree with certification in Medical Billing/Health Claims Examining (e.g., CPC, CPB) plus 5+ years of supervisory or above experience. Experience: Minimum 5 years of medical billing, AR management, and collections experience in a healthcare setting, preferably behavioral health. 3+ years in a supervisory or management role, overseeing multi-facility billing operations. Extensive experience with Ohio Medicaid, MCOs, Aetna OhioRISE, and commercial payers. Prior experience with Netsmart software highly desirable. Benefits and Salary Benefits and Salary: The salary range is $75,000 - $100,000 per year depending on relevant education, experience, and licensure. Wingspan offers competitive benefits for employees and their families, including domestic partners and pets. Comprehensive health and Rx plans, including a zero-cost option. Wellness program including free preventative care Generous paid time off and holidays 50% tuition reduction at Case Western Reserve University for the MNO and MSW programs Defined benefit pension plan 403(b) retirement plan Pet insurance Employer paid life insurance and long-term disability Employee Assistance Program Support for continuing education and credential renewal Ancillary benefits including: dental, vision, voluntary life, short term disability, hospital indemnity, accident, critical illness Flexible Spending Account for Health and Dependent Care Wingspan Care Group is an Equal Opportunity Employer. Wingspan’s policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information, or any other basis protected by applicable federal, state, or local laws. Wingspan also prohibits harassment of applicants or employees based on these protected categories. #J-18808-Ljbffr Wingspan Care Group

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