Medical Billing Manager

Job Description

Job Description

Here at Clinical Care Medical Centers, we are in need of a Billing Manager with in-depth knowledge of Procedural Coding, identifying appropriate ICD-10 coding based on CMS / HCC categories, CPT, HCPS 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 / EDUCATION :

• Certified Professional Coder Certification
• Bi-lingual English / Spanish preferred; must be able to read, write and speak English.
• 3+ years of experience in Managing a Medical Billing Department.
• Moderate computer knowledge : MS Word and 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
• Proper documentation to different level of appeals base on insurance denials
• Communicating with insurance compliance for claim(s) payment / rejections
• Submission of Doctor’s application(s) for credentialing to insurance company(ies) as well as hospitals
• Collects patient payments with by mail or via telephone and ensure payments are properly recorded and processed
• Assist Practice Administrator in updating practice or Doctor’s license(s)including but not limited to county, city and CLIA as well as distributing HEDIS / MRA reports to multiple providers
• Assist in the balancing of copays and Insurance payments for other service facilities
• Transmit Financial Report to Accountant
• Review A / R regularly and take the necessary collection action
• Ensure HEDIS Claims Tracking and Reporting
• Posting payments via ERA and manual posting of all Medicare, Medicaid and Third-Party Payers
• Review accounts for possible assignment and make recommendations to the practice administrator
• Performs other duties as assigned.

At Clinical Care Medical Centers, we are committed to providing 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 believes that diversity and inclusion among our employees is critical to our success as a company.

We support an inclusive workplace where employees excel based on personal merit, qualifications, experience, ability, and job performance.