medical billing supervisor

Balboa United

Why work for us? Balboa Nephrology is the largest kidney care practice in California and participates in a national Medicare program focused on value-based care. Through our joint venture with Evergreen Nephrology we are a growing organization with opportunities for professional and personal growth. We will help you grow in your leadership experiences while learning the new value-based care world. Comprehensive benefits package that includes medical, dental &amp; vision on the 1st of the month 30 days after hire. Employer contribution of up to 7.5% of annual pay for your 401K. Generous paid time off plus 8 paid holidays! Company paid life insurance. Join a fast-growing field - employment of medical and health services managers is projected to grow 32 percent from 2020 to 2030, much faster than the average for all occupations. Voted 4 years in a row as a Top Workplace of San Diego 2020-2024! Our Values: Patient-centered I Accountability I Respect I Innovation I Data-Driven Our Mission: Igniting hope and healing for people with kidney disease through compassionate, innovative care. Work Location: Hybrid Works out of our Hazard Way office in San Diego, CA. Eligible for hybrid schedule upon successful completion of onboarding/training. Position is usually in office 2-3 days a week, based on business needs. Employee must reside within San Diego County, California. Position Summary: This role will have primary responsibility to supervise the claims submission process, ensuring clean claims are properly and timely submitted following payor and internal guidelines. The Supervisor is a working supervisor providing guidance and support to staff within revenue cycle assignment area which may include one or more areas (Eligibility and Authorizations, Claims, Payments and Credits, Accounts Receivable, Medical Records). The Supervisor directs staff in completing assignments using established guidelines, procedures, and policies. Recommends new and revised procedures as needed to improve patient care and key performance indicators. Pay Range: $70,500 - $76,000/annually plus leadership bonus incentive based on performance Essential Duties and Responsibilities: Leads and develops staff to achieve successful Key Performance indicators through guidance and support. Works day-to-day functions of staff as needed. Acts as a resource for staff operational questions. Remains abreast and researches payor policies and procedures, system issues and functions, and billing and collections requirements. Works in collaboration with other leaders to ensure proper coverage within revenue cycle functions. Trains new staff and provides ongoing training. Documents processes and updates to ensure standardized operating procedures are efficient, clear, meaningful, and easily accessible. Performs analysis, research, and audits to ensure informed and smooth operations to support key performance indicators. Presents findings and recommendations in a clear manner to support continual improvement. Promptly and accurately responds to billing inquiries from patients, payers, and internal customers. Continuously identifies issues and trends impacting quality and timely reimbursement and proposes potential solutions. Supports and actively participates in process improvement initiatives. Assists with other duties to support the revenue cycle process and Balboa&rsquo;s core values as assigned. Required Qualifications: Reside in San Diego County, California. 4 years recent and progressive professional medical billing/collection experience within a medical billing environment for a medical group/physician practice. Prior experience utilizing Epic for revenue cycle functions. Strong understanding of the entire revenue cycle process. Demonstrated knowledge of medical terminology, CPT, HCPCS, ICD-10 and modifier codes, including impact on coverage and reimbursement. Knowledge of collection processes and collection laws. Vast payor experience including Medicare, Medi-Cal, HMO, FFS, PPO and IPA&rsquo;s. Strong people management skills with the ability to inspire, coach, develop, and hold teams accountable. Strong analytical and critical thinking skills, with ability to develop proposals. Strong proficiency with Microsoft Windows (ability to navigate, create and rename folders, save, and organize files), Strong proficiency with Microsoft Office products (Outlook, OneNote, Teams, Excel, Word), proficiency with Adobe PDF. Ability to type 30 words per minute. Preferred Qualifications: Nephrology specific experience within revenue cycle. 5 or more years recent experience in professional claims. Recent experience utilizing specific areas within Epic for authorizations, claims edits, payments and credits, account receivable, and medical records. Prior, recent and relevant experience leading staff. CPC certification Education: High School graduate required. Required Skills: Ability to lead Excellent verbal and written communication. Ability to provide excellent customer service. Ability to interpret, adapt and apply guidelines and procedures. Ability to use good reasoning and judgement and react appropriately in emergency situations. Ability to establish and maintain effective working relationships with patients, medical staff, and coworkers. Ability to multitask and stay organized. Detail oriented and ability to prioritize work. Other considerations: Background check required Travel to other sites located within San Diego County may be required Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Supervisory duties &ndash; Yes This position is being handled internally. We are not accepting solicitations from external recruiters or staffing agencies at this time. Language Skills While performing duties, the employee is regularly required to talk, hear, read, write, type and respond in English and understand clinical/medical vocabulary written and spoken. Vision Requirements Vision requirements include close vision, ability to adjust focus, and see color. Physical Demands Physical requirements may vary slightly and should be reviewed with your manager. In general, this position requires the ability to lift up to 35 pounds unassisted; ability to stand for extended periods of time and to perform repetitive stooping, walking, stretching, reaching and some sitting; ability to use full range of body motions required to lift patients, wear a lead apron, and lift and move supplies. Must be able to safely ascend and descend stairs as a core part of the job, with or without reasonable accommodation, when no elevator or lift is present. Work Environment Job required tasks routinely involve a potential for mucous membrane or skin contact with blood, body fluids, tissues or potential spills or splashes. Use of appropriate personal protection measures is required for every healthcare provider in these positions. Require to routinely use standard office equipment such as laptop, computer, mouse, and photocopier. About Balboa United Beginning in 1973, Balboa has grown from two physicians to a comprehensive nephrology team of 52 board certified physicians and 8 advanced practitioners. On January 1, 2018, Balboa Nephrology Medical Group (BNMG) launched Balboa United, a full-service medical practice management services organization. From one small office, BNMG now has 24 clinical offices throughout San Diego, Imperial, Orange and Riverside counties. In addition to office and hospital-based patient care, Balboa physicians manage the dialysis treatments of approximately 4,500 patients at 88 dialysis centers and conduct Nephrology based clinical research at 6 centers throughout Imperial and San Diego counties (California Institute of Renal Research). EEO Statement Balboa United is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available person in every job. Our Company policy prohibits unlawful discrimination based on race, color, creed, religion (including religious dress &amp; grooming), sex (including pregnancy, childbirth or related medical conditions), gender (including gender identity and gender expression), marital status, registered domestic partner status, military status, age, national origin or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), genetic information, sexual orientation, or any other basis protected by applicable federal, state, or local law. We also prohibit unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics. The Company is committed to compliance with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in our operations and prohibits unlawful discrimination by any employee of Balboa United, including managers and co-workers. If you believe you have been subjected to any form of unlawful discrimination, submit a written complaint to your manager or Human Resources (HR). Your complaint should be specific and should include the names of the individuals involved and the names of any witnesses. If you need assistance with your complaint, or if you prefer to make a complaint in person, contact the Company's Human Resources Department. We will immediately undertake an effective, thorough, and objective investigation and attempt to resolve the situation. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Supervisor of Billing

Texas Oncology

<div>Overview:<div></div><div> 
The US Oncology Network is looking for a Revenue Cycle Supervisor to join our team at Texas Oncology. This full-time position will support the Revenue Cycle Surgery Department at our 3001 E. President George Bush Highway Suite 100 location in Richardson, Texas. Typical work week is Monday through Friday, 8:00a - 5:00p.</div><div></div><div> 
As a part of The US Oncology Network, Texas Oncology delivers high-quality, evidence-based care to patients close to home. Texas Oncology is the largest community oncology provider in the country and has approximately 530 providers in 280+ sites across Texas, our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today&mdash;at Texas Oncology, we use leading-edge technology and research to deliver high-quality, evidence-based cancer care to help our patients achieve &ldquo;More breakthroughs. More victories.&rdquo; &reg; in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis.</div><div></div><div> 
The US Oncology Network is one of the nation&rsquo;s largest networks of community-based oncology physicians dedicated to advancing cancer care in America. The US Oncology Network is supported by McKesson Corporation focused on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care.</div> 
What does the position do?
Supervises the day to day revenue cycle operations in order to maximize the collection of medical services payments and reimbursements from patients, insurance carriers, financial aide, and guarantors. Supports and adheres to the US Oncology Compliance Program, to include Code of Ethics and Business Standards, and US Oncology's Shared Values.
Responsibilities:

The essential duties and responsibilities:<ul><li>
Supervises the daily business functions of the patient visit from point of entry to accurate adjudication of the patients' accounts. Scope of responsibilities includes appointment scheduling, insurance eligibility processes; charge processing; claim submission and processing; payment processing; collections and accounts receivable management; denial management; reporting of results and analysis; concurrent and retrospective auditing; proper coding; credentialing; customer services relative to revenue cycle; training and development relative to revenue cycle; analytics, and all other revenue cycle management activities. Resolves escalated and unique revenue cycle issues.</li><li>
Responsible for quality work, meeting deadlines, and adherence to the Practices Standard Operating Procedures (SOPs); regularly audits staffs work to ensure compliance.</li><li>
Monthly, prepares revenue cycle financial analysis, including aged accounts. Monitors and assesses business metrics in order to refine processes and improve Guides individuals and teams toward priorities; clarifies roles and responsibilities of others; coordinates resources to meet objectives. Cascades goals down to staffs annual objectives.</li><li>
Champions new initiatives; acts as a catalyst of change and stimulates others to change; paves the way for needed changes; manages implementation effectively. Steps forward to address difficult issues; puts self on the line to deal with important problems; takes ownership and accountability.</li><li>
Develops, implements, and maintains the Practice's revenue cycle training materials. Conducts training of SOPs, systems, metrics, government regulations, and etc.</li><li>
Responsible for the overall coordination of front office duties to include scheduling, check-in, and co-pay/co-insurance collection.</li><li>
Attracts high caliber people, accurately assesses strengths and development needs of employees; provides timely, specific feedback and helpful coaching; provides challenging assignments and opportunities for development. Responsible for interviewing, recommending hires, assessing performance, recommending salary changes, and progressive discipline. Enforces adherence to the Practice's and US Oncology policies.</li><li>
Other duties as requested or assigned.</li></ul>
Qualifications:

The ideal candidate for the position will have the following background and experience:
<ul><li>Associates degree in Finance, Business or equivalent OR four years revenue cycle experience required.</li><li>
At least four (4) years of medical revenue cycle work experience required with a consistent track record of achieving metrics.
</li><li>Two years experience managing, delegating, and following up on work priorities of others is strongly desired.
</li><li>Individual must have strong knowledge of medical insurance billing and collections with CPT, ICD9, and HCPC coding and medical terminology, as well as an overall understanding of managed care products (HMO, PPO, etc).
</li><li>Proficiency in Microsoft Office (Outlook, Excel, Word, and PowerPoint).</li></ul> 
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. 
Work Environment:
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.</div>

Supervisor, Revenue Cycle

Guardian Pharmacy

<div>Phoenix, Arizona, United States of America
Extraordinary Care. Extraordinary Careers.
With one of the nation&rsquo;s largest, most innovative long-term care pharmacy services providers, there is no limit to the growth of your career.
Saliba&rsquo;s Extended Care Pharmacy, a member of the Guardian family of pharmacies, has an exciting opportunity for you to join our rapidly growing team in Phoenix, Arizona.
Why Saliba&rsquo;s Extended Care Pharmacy? We&rsquo;re reimagining medication management and transforming care.
Who We Are and What We&rsquo;re About:
Our core focus is delivering customized medication management solutions to support healthcare organizations serving seniors and individuals with complex care needs. With our comprehensive suite of tech-enabled pharmacy services and a dedicated team of professionals committed to enriching the lives of those we serve, we are redefining how pharmacy care is delivered.
We offer an opportunity to learn and grow your career in a fast-paced, diverse, and inclusive environment. If you are looking for a challenging, team-oriented environment in which you can put your expertise to work, then this is the place for you.
Position Details:<ul><li>
Schedule: Monday - Friday, 9:00 am - 5:30 pm</li><li>
Salary: $51,251 - $65,000 + Bonus</li><li>
Location: Saliba's Pharmacy: 925 E Covey Lane, Phoenix, AZ 85024</li></ul>
Requirements:<ul><li>
Certified Pharmacy Technician License</li></ul><div>
Support the team with all billing/collections functions and ensure they are performed in a timely and accurate manner. Ensure all relevant input is complete, accurate, and fully adjudicated to ensure margin is maximized. Responsible for the integrity of all batches and their timely posting. Handle escalated billing issues and make sure full customer satisfaction is reached for residents, responsible parties and facility staff. Work with other departments as it relates to billing and claims adjudication. 
 
Attributes Required: 
<ul><li>Work Ethic/Integrity &ndash; must possess intrinsic drive to excel coupled with values in line with company philosophy</li><li>Leadership &ndash; ability to lead project teams to deadlines, while maintaining strong team orientation</li><li>Relational &ndash; ability to build relationships with business unit management and become &ldquo;trusted advisor&rdquo;</li><li>Strategy and Planning &ndash; ability to think ahead, plan and manage time efficiently</li><li>Problem Solving &ndash; ability to analyze causes and solve problems at both a strategic and functional level</li><li>Team Oriented &ndash; ability to work effectively and collaboratively with all team members</li></ul> 

Essential job functions (include the following): 
<ul><li>Manage billing, A/R, and collection functions to ensure high level of customer service is maintained; manage productivity to metrics to include production &amp; error rates</li><li>Supervise team members, to include: hiring, training, evaluating, scheduling, coaching, disciplining, etc.</li><li>Lead team in development and ongoing updates for all operations training manuals to assist in new employee training process; ensure written policies and procedures are maintained and updated for each area/function</li><li>Assist in month end close processes, including statement prep, analysis reports, etc.</li><li>Provide analysis of operational reports such as unbilled revenue; provide detailed explanation of variances and corrections</li><li>Lead and participate in regular team meetings for direct reports and coordinate multi-department meetings to ensure good communication and issue resolution; participate and lead discussions as requested for operational meetings</li><li>Serve as subject matter expert on all department operating systems and programs, including QS/1, DocuTrack, banking software, and others, in order to provide assistance and analysis to department</li><li>Ensure all claims are adjudicated and batches composited and/or posted in a timely manner</li><li>Ensure the PA/rejection queue is updated and resolved in a timely manner</li><li>Quality check all patient and insurance information data entered in the system</li><li>Have a thorough working knowledge of all department functions in order to assist/support clearing bottlenecks in workflow and ensuring the most efficient processes are followed</li><li>Assist in answering phones and providing customer service</li><li>Provide customer account audits when occasions arise</li><li>Become cross trained in all areas of department function so as to assist in clearing bottlenecks in work flow</li><li>Lead by example in all areas of role and supporting the non-negotiable attributes: attitude, dependability, commitment, productivity, efficiency and upholding policies and procedures</li><li>Other essential functions and duties may be assigned as needed</li></ul> 

Education and/or Certifications: 
<ul><li>High School Diploma or GED required; Bachelor's Degree preferred</li><li>Pharmacy Technician license/certification/registration (per state requirements); National Certification preferred (PTCB) may be required (pharmacy specific)</li></ul> 

Skills and Qualifications: 
<ul><li>5+ years of related experience (advanced degree may substitute for experience); at least 3 years in high volume claims processing field</li><li>Advanced computer skills; pharmacy operations system experience preferred/required</li><li>Ability to work independently and deliver to deadlines</li><li>Ability to solve problems with minimal direction</li><li>Great attention to detail and accuracy</li><li>Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines</li><li>Quality minded; motivated to seek out errors and inquire when something appears inaccurate</li></ul> 

Work Environment: 
<ul><li>Ability to work flexible hours</li></ul></div>
What We Offer:
Emotional well-being and physical health are important, which is why our employees receive a generous benefits package and a work culture that supports our core value of, &ldquo;Treat others as you would like to be treated.&rdquo;
Compensation &amp; Financial<ul><li>
Competitive pay</li><li>
401(k) with up to 3.5% company match (1)</li></ul>
Family, Health &amp; Insurance Benefits (1), (2)<ul><li>
Multiple health plan options including copay (FSA-eligible) and HSA eligible plans</li><li>
Wellness Incentive Program</li><li>
Dental and Vision plans</li><li>
Company-paid basic life, AD&amp;D and long-term disability coverage</li><li>
Optional employee, spouse, and child life/AD&amp;D insurance</li><li>
Optional accident, critical illness, and short-term disability coverage</li><li>
Dependent Care Flexible Spending Accounts</li><li>
Employee Assistance Program (EAP)</li></ul>
Time Off<ul><li>
Paid holidays and sick days</li><li>
Generous vacation benefits based on years of service</li></ul>
(1) Eligibility begins the first of the month following 30 days of employment
(2) Full-time employees only, excluding EAP which is available to all Guardian employees
The Guardian Difference
Our clients require pharmacy services that aren&rsquo;t &ldquo;cookie cutter.&rdquo; That&rsquo;s why every Guardian pharmacy is locally operated and empowered with the autonomy to tailor their business to meet their clients&rsquo; needs.
Our corporate support offices, based in Atlanta, Ga., provide services such as human resources, business intelligence, legal, and marketing to promote the success of each Guardian location.
Regardless of your role at Guardian, your voice and talents matter. Because healthcare is an ever-changing industry, we encourage innovative thinking, intellectual curiosity, and diverse viewpoints to ensure we stay competitive in today&rsquo;s dynamic business environment.
At Guardian, we are dedicated to fostering and advancing a diverse and inclusive workforce.
Join us to discover what your best work truly looks like.</div>

Pharmacy Technician - Billing Supervisor

Advanced Health Care

<div>Description:

The Patient Account Coordinator is responsible for managing patient accounts and billing processes related to services provided within the facility. This position ensures accurate and timely processing of claims, billing, and account management while maintaining positive relationships with patients, families, and insurance providers.
Schedule: Full-Time, Weekdays, 8 Hour Shifts
Primary Responsibilities and Duties:<ul><li>
Manage patient accounts and verify patient information, including demographics, insurance coverage, and financial data for residents.</li><li>
Process and submit claims to insurance companies and government agencies for services, ensuring compliance with regulations and payer requirements.</li><li>
Monitor and follow up on unpaid claims, denials, and rejections specific to billing, taking appropriate action to resolve issues and secure payment.</li><li>
Respond to patient and family inquiries regarding billing, insurance coverage, and payment arrangements, providing clear and accurate information.</li><li>
Collaborate with clinical staff and other departments to ensure accurate documentation and coding of services rendered.</li><li>
Maintain accurate and up-to-date patient account records in the billing system, tracking account status and payment history.</li><li>
Prepare and distribute patient statements, invoices, and other billing-related correspondence in a timely manner.</li><li>
Process patient payments, adjustments, and refunds for services, reconciling accounts and maintaining accurate financial records.</li><li>
Assist with month-end closing procedures, including preparing reports and analyzing billing trends.</li><li>
Stay informed of industry changes and updates related to healthcare billing, coding, and regulations, ensuring compliance and optimal reimbursement.</li><li>
Perform all other duties assigned by the billing manager or designated supervisor, demonstrating adaptability and a commitment to continuous improvement.</li></ul>
Requirements:

Job Qualifications:<ul><li>
High school diploma or equivalent; associate's degree or certification in medical billing, healthcare administration, or related field preferred.</li><li>
1 year of experience in medical billing with a focus on nursing facilities preferred but not required.</li><li>
Strong understanding of billing processes, insurance regulations, and reimbursement methodologies.</li><li>
Proficiency in medical billing software and electronic health records (EHR) systems.</li><li>
Excellent analytical, problem-solving, and organizational skills, with a high level of attention to detail.</li><li>
Strong communication and interpersonal skills, with the ability to interact effectively with patients, families, and insurance providers.</li><li>
Knowledge of relevant healthcare regulations, policies, and procedures, including HIPAA, Medicare, and Medicaid guidelines.</li><li>
Ability to work independently and manage time effectively, prioritizing tasks and meeting deadlines.</li><li>
Experience with Microsoft Office applications, including Excel and Word.</li></ul>
Physical Requirements:<ul><li>
Capability to perform physical tasks such as bending, standing, walking, and climbing stairs for extended periods.</li><li>
Manual dexterity and hand-eye coordination for handling paperwork, typing, and using office equipment.</li><li>
Visual and auditory acuity to review documents, communicate effectively, and respond to resident inquiries.</li><li>
Stamina and physical endurance to handle a fast-paced work environment and meet deadlines for billing submission and account management.</li><li>
Ability to lift and carry boxes of medical records and supplies, as needed, up to 5lbs.</li><li>
Ability to bend, stoop, kneel, and reach to access files, storage cabinets, and other work-related materials.</li><li>
Ability to work in an office environment with moderate noise levels and occasional interruptions.</li><li>
Maintain regular attendance and timeliness as set forth within the work schedule designated by the department supervisor/manager.</li></ul></div>

Patient Account Coordinator (PAC)

Beth Israel Lahey Health

<div>
 
 When you join the growing BILH team, you're not just taking a job, you&rsquo;re making a difference in people&rsquo;s lives.
 
 
 
 Identifies, reviews, and interprets third party payments, adjustments and coding denials for all professional services. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and other coding needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects. (remote)
 
 
 
 Job Description
 
 
 
 
 Essential Duties &amp; Responsibilities
 
 including but not limited to:
 
 
 
 Coding Responsibilities
 
 
 
 <ul>
 <li>
 Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.
 </li>
 <li>
 Periodic review of codes, at least annually or as introduced or required.
 </li>
 <li>
 Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.
 </li>
 <li>
 Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.
 </li>
 <li>
 Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.
 </li>
 <li>
 Maintains certification requirements for coding.
 
 
 </li>
 </ul>
 
 Follow Up Responsibilities
 
 
 
 <ul>
 <li>
 Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
 </li>
 <li>
 Responds to incoming insurance/office calls with professionalism and helps to resolve callers&rsquo; issues, retrieving critical information that impacts the resolution of current or potential future claims.
 </li>
 <li>
 Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
 </li>
 <li>
 Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
 </li>
 <li>
 Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments.
 </li>
 <li>
 Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
 </li>
 <li>
 Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
 </li>
 <li>
 Reviews/updates all accounts for write-offs and refunds.
 </li>
 <li>
 Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients&rsquo; portion due.
 </li>
 <li>
 Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
 </li>
 <li>
 Handles incoming department mail as assigned.
 </li>
 <li>
 Attends meetings and serves on committees as requested.
 </li>
 <li>
 Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
 </li>
 <li>
 Provides and promotes ideas geared toward process improvements within the Central Billing Office.
 </li>
 <li>
 Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
 </li>
 <li>
 Completes projects and research as assigned.
 </li>
 <li>
 Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.
 
 
 </li>
 </ul>
 
 Secondary Functions
 
 
 
 <ul>
 <li>
 Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
 </li>
 <li>
 Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
 </li>
 <li>
 Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
 </li>
 <li>
 Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
 </li>
 <li>
 Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
 </li>
 <li>
 Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
 </li>
 <li>
 Assists other staff as required in the completion of daily tasks or special projects to support the department&rsquo;s efficiency.
 </li>
 <li>
 Performs similar or related duties as assigned or directed.
 
 
 </li>
 </ul>
 
 Education &amp; Professional Development
 
 
 
 <ul>
 <li>
 Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD&rsquo;s), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
 </li>
 <li>
 Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
 </li>
 <li>
 Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
 
 
 </li>
 </ul>
 
 Organizational Requirements
 
 
 
 <ul>
 <li>
 Maintain strict adherence to the Lahey Health Confidentiality policy.
 </li>
 <li>
 Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
 </li>
 <li>
 Comply with all Lahey Health Policies.
 </li>
 <li>
 Comply with behavioral expectations of the department and Lahey Health.
 </li>
 <li>
 Maintain courteous and effective interactions with colleagues and patients.
 </li>
 <li>
 Demonstrate an understanding of the job description, performance expectations, and competency assessment.
 </li>
 <li>
 Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
 </li>
 <li>
 Participate in departmental and/or interdepartmental quality improvement activities.
 </li>
 <li>
 Participate in and successfully completes Mandatory Education.
 </li>
 <li>
 Perform all other duties as needed or directed to meet the needs of the department.
 
 
 </li>
 </ul>
 
 Minimum Qualifications
 
 
 
 Education: High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate
 
 
 Licensure, Certification &amp; Registration: CP (Certified Professional Coder through AAPC), CPC-A (Certified Professional Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA)
 
 
 Experience: 1-2 years of experience in billing, coding, denial management environment related field.
 
 
 
 Skills, Knowledge &amp; Abilities
 
 
 
 <ul>
 <li>
 Ability to work independently and take initiative
 </li>
 <li>
 Good judgment and problem solving skills
 </li>
 <li>
 Excellent organizational skills
 </li>
 <li>
 Ability to interact and collaborate effectively and tactfully with staff, peers and management.
 </li>
 <li>
 Ability to promote team work through support and communication.
 </li>
 <li>
 Ability to accept constructive feedback and initiate appropriate actions to correct situations.
 </li>
 <li>
 Ability to work with frequent interruptions and respond appropriately to unexpected situations.
 
 
 </li>
 </ul>
 
 Pay Range
 
 
 
 $25.00 - $34.00
 
 
 The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
 
 
 As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.
 
 
 More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
 
 
 Equal Opportunity Employer/Veterans/Disabled
</div>

Billing & Certified Coding Specialist I (Remote)

Dermatology - Orange County

Dermatology Medical office in Orange County looking for Lead Medical Assistant /Office Administrator.Duties include greeting patients, overseeing a medical office, running billing reports, creating excel spreadsheets, rooming patients, taking histories, answering heavy phones, computerized scheduling, and product sales.Requirements: Must have two years minimum experience as a supervisor in a dermatology or plastic surgery medical office. Must have excellent phone skills, be familiar with medical terminology, computer skills, and ability to multi task. Must have a pleasant disposition, ethical, hard working, energetic, honest, and a team player. All candidates will be asked for multiple references and thorough background information. Please only those with the above requirements need apply.Job Type: Full-timePay: From $18.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Vision insurance</li></ul>Medical Specialty:<ul><li>Dermatology</li><li>Plastic Surgery</li></ul>Ability to Relocate:<ul><li>Orange, CA: Relocate before starting work (Required)</li></ul>Work Location: In person

Certified Medical Assistant Lead

ExamWorks

<div>
 
 Exam Works is looking for a Medical Coding Specialist to join our team remotely!
 
 
 
 <ul>
 <li>
 Must possess current coding certification in CPC. CPMA certification &amp; Certified Life Care Planner certification preferred.
 
 
 </li>
 </ul>
 The
 
 Medical Coding Specialist
 
 (Internally called a Coding Specialist) is responsible to create and write reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and this position is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types and ensures reviews are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.
 
 
 Schedule for this role is:
 
 Monday - Friday 8am-5pm EST
 
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Receive and input client and examinee data in the system database.
 </li>
 <li>
 Sort and verify each claim.
 </li>
 <li>
 Process and review each claim and address all necessary modifications manually. Contact Client as needed
 </li>
 <li>
 Perform quality assurance on every case prior to completion.
 </li>
 <li>
 Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
 </li>
 <li>
 Process client invoicing in accordance with the client&rsquo;s fee schedule.
 </li>
 <li>
 Handle and responds promptly to incoming calls, emails or faxes from clients requesting report status and/or information.
 </li>
 <li>
 Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim.
 </li>
 <li>
 Provide testimony in court as to the content of prepared reports, as required. Travel as necessary.
 </li>
 <li>
 Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
 </li>
 <li>
 Perform quality assurance on various coding related reviews.
 </li>
 <li>
 Perform other duties as assigned.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Education and/or Experience
 
 
 
 <ul>
 <li>
 High school diploma or equivalent required.
 </li>
 <li>
 Minimum one year medical billing experience; or equivalent combination of education and experience required.
 
 
 </li>
 </ul>
 
 Certificates, Licenses, Registrations
 
 
 
 
 Must Possess Current Coding Certification In
 
 
 
 <ul>
 <li>
 OASIS, RAC-CT, CCS, CPC, RHIT or RHIA. CPMA certification preferred.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Must have minimum of one year medical billing experience; or equivalent combination of education and experience required.
 </li>
 <li>
 Must have a full understanding of aspects of medical billing.
 </li>
 <li>
 Must demonstrate understanding of the various types of medical billings and ability to identify which system database should be used.
 </li>
 <li>
 Must be able to cross reference different types of billings to ensure consistency in the review process.
 </li>
 <li>
 Must possess knowledge of standard fee schedule review, UC&amp;R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing and CMS reimbursement guidelines.
 </li>
 <li>
 Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
 </li>
 <li>
 Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
 </li>
 <li>
 Must have a full understanding of HIPAA regulations and compliance.
 </li>
 <li>
 Must be a qualified typist with a minimum of 35 W.P.M.
 </li>
 <li>
 Ability to follow instructions and respond to managements&rsquo; directions accurately.
 </li>
 <li>
 Ability to work independently, prioritize work activities and use time efficiently.
 </li>
 <li>
 Must be able to maintain confidentiality.
 </li>
 <li>
 Must be able to demonstrate and promote a positive team -oriented environment.
 </li>
 <li>
 Must be able to stay focused and concentrate under normal or heavy distractions.
 </li>
 <li>
 Must be able to work well under pressure and or stressful conditions.
 </li>
 <li>
 Must possess the ability to manage change, delays, or unexpected events appropriately.
 </li>
 <li>
 Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
 
 
 </li>
 </ul>
 
 ExamWorks
 
 is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
 
 
 
 ExamWorks, LLC
 
 is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
 
 
 
 Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
 
 
 
 
 
 ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
 
 
 
 
 TAGS
 
 
 CPC, CPMA, Medical Billing, Medical Billing Specialist
</div>

Medical Coding Specialist (32635)

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