Dy Manager/Manager Medical Biller (2B & 3A)

• Having proper knowledge of submitting claims: Paper, electronic
• Knowledge of medical billing forms: CMS-1500 vs UB-04, Medicare and Medicaid/MCO
• Prior experience in working with clearinghouse – balancing claims: Submissions/Denials/Rejections/Pending/Not Received. Balancing Reports to ensure all vouchers captured and resolved timely
• Understand the components of a clean claim to ensure first time submission
• Provides that insurance verification is completed timely – notifies staff of eligibility concerns, corrects encounter data
• Complies with payor-specific requirements
• Knowledge of coding for services (dx and cpts) and procedures
• Works denials timely and is proactive in denial prevention. Monitors and communicates trends, makes appropriate corrections and resubmissions.
• Assists with revenue recognition and preparation of key charge backup
• Ability to post payments and adjustments timely and accurately. Understands RAs and CARCs and appropriate posting and subsequent actions
• Ability to post Credit Card transaction/follow up on expired, Check posting, EFT validation and posting
• Previous knowledge of posting via ERA and manual intervention, audit patient accounts for proper posting
• Resolving secondary insurance and coordination of benefits
• Researches variances and reports findings to direct supervisor
• Balances grant documentation ensuring all members are captured appropriately
• Work Insurance Aging and Patient A/R – understand and report aged accounts and refund/credit balance scenarios
• Implement and optimize billing workflows, tools, technologies
• Works rejections timely and resubmit timely
• Works with appropriate departments to complete corrections of rejections
• Ability to follow up with insurance company with corrected claims, including previous claim information
• Capitated plan reconciliation
• Exceptional communication skills – for patient and insurance company impact
• Stay informed of reimbursement changes, relay trends to supervisor

• Front End Revenue Cycle skills a plus: Time of Service Payments, Insurance Collection and Verification a plus

• Education in Medical Billing/Certification a plus

• Previous communications with insurance companies

• Ability to work with patient clientele

• Behavioral and Mental Health Service background a plus

• DHS Invoice knowledge a plus

• Proficiency in EHRs systems, billing software and payer portals

• Knowledge of contract components

• Detail oriented and organized

• Microsoft Excel and Word

• Associate degree required (bachelor’s degree in business or related).

• 6 -12 years’ experience as a Medical Biller.

• Solid understanding of billing software and electronic medical records.

• Self-motivated and self-directed; able to work without supervision.

• Required to work in shifts. Based on business/project requirement will work in US hours.
• Prior work experience in MNC & matrix organization.

• Frequently serves as a representative of QBSS to various organizations within the community, displaying courtesy, tact, consideration, and discretion in all interactions.

• The position requires direct one-on-one as well as group basis interaction with the management team.

Mancraft Consulting