Certified Medical Biller Coder

Benefits :

• 401(k) matching
• Competitive salary

Role Summary

The Billing Lead oversees EverCare's billing operations, ensuring timely, accurate, and compliant revenue capture across multiple states and from multiple payers. This role demands both hands-on technical expertise and leadership : someone who understands the inner workings of multiple EHRs / billing systems, can drive process improvement, optimize reimbursement strategies, ensure audit readiness, and build a high-performing billing team that supports the mobile mental health care model inside long-term care facilities.

Key Accountabilities

Lead, manage, and hold accountable the billing team - including credentialing, claims specialists, and billing professionals - to ensure accuracy, efficiency, and compliance in all billing operations while driving consistent cash flow and organizational success. Hire, onboard, train, mentor, and evaluate team members. Build a culture of continuous improvement, accountability, and collaboration.

Oversee timely and accurate preparation, submission, and follow-up on claims for 13+ payers across multiple states. Ensure insurance verification processes are reliable and efficient. Apply payer-specific knowledge and coding sequence strategies to maximize allowable reimbursements while staying fully compliant. Manage and monitor payer portals for claim status, rejections, and communication.

Ensure providers are properly credentialed / enrolled with payers; monitor renewals to avoid lapses. Liaise with payers and networks to manage enrollments, re-enrollments, and new payer additions.

Ensure proper CPT / ICD coding and documentation to support claims. Optimize reimbursement through accurate code ordering, modifier usage, and alignment with payer rules.

Measure, monitor, and improve revenue cycle KPIs (A / R days, denial rate, clean claim rate, etc.). Track, reconcile, and manage accounts receivable to minimize aging and improve collections. Continuously refine billing practices to capture the maximum legitimate revenue possible.

Manage and evaluate multiple EHR / billing software tools. Lead system migrations / upgrades; ensure data integrity and minimal disruption. Utilize reporting tools and dashboards to provide actionable insights for leadership.

Stay current with payer regulation changes, state Medicaid / Medicare rules, and coding updates. Maintain compliant billing practices; ensure documentation satisfies audit requirements. Conduct regular internal audits and prepare for external reviews as needed.

Provide regular revenue and billing performance reports to the Finance Lead. Forecast revenue, including impacts of denials, rate changes, or payer delays. Manage billing department budget and vendor relationships.

Write, maintain, and update Standard Operating Procedures (SOPs) for all billing processes. Ensure staff adhere to procedures and perform internal process audits.

Work closely with clinical and operations teams to ensure documentation supports billing. Engage payer representatives for escalated or complex issues. Coordinate with IT for system integration, data extraction, and vendor management.

Qualifications

Success Metrics / KPIs

Attributes / Fit

Core Values Alignment

The Billing Lead is expected to model these values in every aspect of leadership and decision-making, ensuring the billing function not only performs at a high level but also reflects the culture we are committed to building.

This is a remote position.

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