Medical Billing Manager

About the role

Clinical Care Medical Centers seeks a Billing Manager with extensive knowledge of procedural coding, including ICD-10 coding based on CMS/HCC categories, CPT, HCPCS CMS 1500 form, HEDIS, MRA, Super Bill, electronic claims submission and clearing house operations, EOB and payments, denials and appeals, billing, collections and appeals processes, and Medicare and Medicare Advantage billing methodology and processes.

Qualifications/Requirements

• Professional Coder Certification
• Bi-lingual English/Spanish preferred
• Experience in managing a medical billing department
• Moderate computer knowledge: MS Word, MS Excel, internet, document with Electronic Health Records and/or authorization system with minimal typing/spelling errors, send e-faxes and email
• Strong people skills; independent decision making and customer service oriented
• Strong organizational skills
• Credentialing experience, preferred

Essential Duties and Responsibilities

• Review medical records to identify if appropriate ICD-10 coding based on CMS/HCC categories is correct for billing purposes
• Create and submit insurance claims to different insurance companies
• Process patients’ billing, statements, reimbursement claims, post transaction and data
• Properly document different levels of appeals based on insurance denials
• Communicate with insurance compliance for claim(s) payment/rejections
• Submit doctor’s applications for credentialing to insurance companies and hospitals
• Collect patient payments by mail or via telephone and ensure payments are properly recorded and processed
• Aid in updating practice or doctor’s licenses including but not limited to county, city and CLIA, and distribute HEDIS/MRA reports to multiple providers
• Assist in balancing copays and insurance payments for other service facilities
• Transmit financial reports to accountant
• Review A/R regularly and take necessary collection actions
• Ensure HEDIS Claims Tracking and Reporting
• Post payments via ERA and manually post all Medicare, Medicaid and third-party payers
• Perform other duties as assigned

Benefits

Clinical Care Medical Centers is committed to creating an environment of mutual respect where equal employment opportunities are available to all applicants and employees without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military and veteran status, and any other characteristic protected by applicable law. Clinical Care Medical Centers supports an inclusive workplace where employees excel based on personal merit, qualifications, experience, ability, and job performance.