FORTA’S MISSION:
Forta is clearing the path to quality healthcare by delivering the best possible outcomes with the utmost convenience. 1 in 36 children [CDC, 2023] is diagnosed to be on the autism spectrum. Currently, autism support via Applied Behavior Analysis (ABA) is difficult to access and the delivery model must be expanded to provide earlier access to families.
Forta is not only providing ABA services to our clients, but we’re also improving the future of the ABA experience for families by creating software and predictive algorithms that elevate clinicians to work smarter by surfacing the latest and most relevant case data. We are working diligently to continuously improve the patient journey and deliver personalized care by applying smart technology and investing in the growth of our world-class team.
We are seeking a dynamic and hands-on Medical Billing and Collections Manager to join our startup team. This role is pivotal in ensuring the smooth operation of our billing and collections processes, requiring someone who can actively manage, execute, and optimize day-to-day operations while leading the team. The ideal candidate will not only provide strategic oversight but will also be deeply involved in resolving billing challenges, optimizing workflows, and mentoring team members to drive efficiency and results.
Key Responsibilities:
Billing Management:
- Lead and participate in the daily operations of the medical billing department, ensuring accurate and timely claims submission to insurance providers, including Medicare, Medicaid, and direct patient billing.
- Actively monitor and work through claim denials, rejections, and resubmissions, taking direct action on complex cases to improve reimbursement rates.
- Ensure proper coding practices and compliance with payer requirements, regularly reviewing claims for accuracy and identifying trends in denials.
- Conduct hands-on audits of billing processes to verify compliance with industry regulations (ICD, CPT, HCPCS) and optimize revenue collection.
Collections Management:
- Develop and oversee collection strategies while personally handling high-priority, escalated cases to minimize outstanding receivables and maximize cash flow.
- Actively monitor aging reports, take ownership of follow-ups on unpaid or denied claims, and work directly with payers or patients to resolve outstanding balances.
- Establish and implement best practices for collection procedures while maintaining professional relationships with patients, payers, and external collection agencies.
Team Management and Development:
- Manage, mentor, and actively support the billing and collections team, providing hands-on training and direct involvement in problem resolution.
- Conduct regular team meetings to review performance, address challenges, and implement workflow improvements.
- Work alongside team members in real-time to troubleshoot issues, coach staff on best practices, and reinforce accountability for results.
- Actively coach and provide constructive feedback to team members, fostering a collaborative and high-performing work environment.
Reporting and Data Analysis:
- Generate and analyze billing and collections reports, taking an active role in identifying trends and developing solutions to improve performance.
- Work within billing software and Excel to create actionable insights, ensuring accuracy in financial reporting and AR tracking.- Implement corrective actions based on data analysis to improve financial outcomes.
- Continuously monitor KPIs such as collection rates, denial trends, and AR days, implementing corrective actions to improve financial outcomes.
Compliance and Regulatory Oversight:
- Ensure all billing and collections activities adhere to HIPAA, Medicare, Medicaid, and payer-specific regulations.
- Stay up to date with coding changes and regulatory updates, implementing necessary adjustments to keep billing and collections processes compliant.
- Proactively monitor internal processes to ensure adherence to industry standards and prevent compliance risks.
Technology and Process Improvement:
- Work closely with IT and cross-functional teams to enhance billing software capabilities, identifying opportunities for automation and efficiency gains.
- Actively test, troubleshoot, and implement new billing system features, ensuring seamless adoption by the team.
- Identify bottlenecks and recommend workflow improvements, balancing automation with hands-on intervention where necessary.
Strategic Leadership & Hands-On Execution:
- Lead by example, balancing high-level strategy with active participation in daily billing and collections operations.
- Partner with senior leadership to establish financial goals, budgets, and revenue cycle forecasts while ensuring execution at the ground level.
- Provide real-time support and problem-solving to drive efficiency, ensuring the team consistently meets performance targets.
Qualifications:7+ years of experience in medical billing and collections, with at least 3 years in a leadership role.1-3 years of experience, specifically in ABA (Applied Behavior Analysis) billing and collections, is a plus.Proven ability to manage teams while also taking an active role in hands-on billing, collections, and revenue cycle optimization.Strong experience in healthcare billing, coding (ICD, CPT, HCPCS), claims processing, and payer regulations, including Medicare and Medicaid.Demonstrated success in reducing AR days, improving cash flow, and implementing process improvements in a fast-paced environment.Skills and Competencies:Strong leadership and team management skills, with the ability to lead while working alongside the team to ensure success.Advanced proficiency in data analysis, reporting, and Excel to drive insights and revenue cycle performance improvements.Excellent communication, problem-solving, and negotiation skills to handle complex payer relations and patient billing inquiries.Hands-on experience working with billing software, troubleshooting issues, and implementing workflow enhancements.Deep understanding of healthcare regulations, compliance requirements, and industry best practices.Ability to work cross-functionally with IT, finance, and clinical teams to drive system enhancements and operational efficiencies.Apply Today!
We are looking for you! A driven, innovative, client-focused individual to join our team as we innovate the care and tools available to neuro-diverse families. If this position sounds like the opportunity you have been searching for, we want to speak with you!
We look forward to working with you!
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Forta is a Drug-Free Workplace/ EO employer – M/F/Veteran/Disability.
