Billing SME

**This is a Remote Position**

About Zealie:
Zealie is a fast-growing Medical Billing Services company specializing in the Behavioral Healthcare industry. Our clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis. Our state of the art proprietary technology provides data analytics and revenue prediction tools to our clients to help them make strategic business decisions to grow their business. We are committed to delivering exceptional products and services to our clients and believe that our Utilization Review team plays a crucial role in achieving this mission. We are seeking motivated individuals with a desire to be a part of a winning team.

Job Summary:
The Billing SME is a crucial role in the Revenue Cycle Management. This position ensures accurate and efficient billing processes, effective communication within the team, and implementation of any payer rules. The SME will handle claims escalated to the Billing team for review, resubmission and correction.

Responsibilities and Duties:

• Review of escalated claims:

• Update tracker with total amount of escalations for each facility
• Handle all resubmissions that are required
• Handle all the corrections in CMD and thoroughly document actions taken on the claim in RCM and Zion
• Ensure trends are tracked for the billing team to make any necessary changes to their billing practices.

• Billing Software Management:

• Verify correct information is entered into CMD for patient demographics
• Bulk submission of claims
• Sending Corrected claims in CMD

• Process Monitoring and Communication:

• Update tracker with total of escalations and completion date
• Verify that billing has been submitted correctly and efficiently.
• Communicate with Team Lead on any outstanding tasks

• Operational Efficiency:

• Monitor and ensure that all billing processes are accurate and timely.
• Collaborate with internal teams to resolve any billing-related issues or discrepancies.

• VA and Tricare Claim Submission for all facilities

• Under direct supervision of Billing Assistant Director, would submit claims for all facilities that have Tricare and VA patients.
• Closely monitor trends that occur with claim denials
• Stay current on requirements for VA and Tricare

Qualifications and Skills:

• Experience:

• Proven experience in healthcare billing, with a strong understanding of claim verification and submission processes.
• Familiarity with billing software, particularly Collaborate MD, is preferred.

• Education:

• High School Graduate or equivalent; additional certification in medical billing or coding is a plus.

• Skills:

• Communication: Excellent verbal and written communication skills to effectively coordinate with team members and address billing issues.
• Organizational Skills: Strong ability to manage multiple tasks and priorities in a dynamic environment.
• Technical Proficiency: Experience with healthcare billing software and electronic health record (EHR) systems.
• Analytical Skills: Ability to analyze billing data, resolve issues, and ensure accurate claim submissions.
• Attention to Detail: High level of accuracy and attention to detail in all aspects of billing and claims processing.

• Additional Preferred Experience:

• Familiarity with the Behavioral Healthcare industry, including billing for substance use disorder treatment and mental health services.
• Prior experience working remotely is a plus.