Medical Billing Manager - Hospital Claims

Job Family:

Business Operations

Travel Required:

Up to 10%

Clearance Required:

None

What You Will Do:

The Billing Process Manager is responsible for the overall operation and administration of the billing process for the Company in alignment with the Company’s billing services.

This position can be based either in Gardena, CA; San Marcos, CA or Lewisville, TX. Questions regarding this position, feel free to call Chris Rivera (Talent Acquisition Manager) at (424) 430-3111.

This critical leadership position will coordinate the resolution of all billing issues, provide high-level analysis and manage the accounts receivable process in conjunction with the client, operations team, and corporate finance group with the goal of optimizing cash collections for the Company.

This position works closely with the operations, Information Services and Finance departments and works closely with clients. The Billing Process Manager will perform any and all related job duties as assigned.

• Possess strong leadership knowledge and skills to set clear direction, concise communication and drive results

• Excellent understanding of integration of applications and their impact on business process and operations.

• Ability to meet deadlines, possess high level of energy and professional acumen, and be client service oriented.

• Proactive disposition in anticipating problems and offering solutions to ensure a quality outcome

• Strong organizational, written, verbal and presentations skills

• Effectively and collaboratively works well with all level’s staff with clients and within the Company

• This position will focus on building edits and workflow as it pertains to the billing process and various claims editing systems utilized by the company.

• The position will lead all aspects of the billing outsource provider implementation process and manage the on-going relationship.

• The BPM will work with client’s IT department to define solutions to needs or problem areas and determines scope of investigation required to obtain solution. Solutions may include installation of alternate methods and procedures, changes in methods and practices, or redesign of products or services.

• The BPM prepares written deliverables for client and Guidehouse management and client application requirements.

• IT planning and needs assessments, system selection and implementation, project management, upgrade coordination and testing, custom programming, application support, design or build, interim management, business operational analysis and workflow redesigns

• Resources, project timeline management.

• Understands clinical governance structure characteristic to hospitals.

• Understand change control processes internal and external to the project.

• Monitor all billing data information and unbilled claims information.

• Assure proper communication of all billing and cash collection information to appropriate operations, sales and finance groups.

• Ensure compliance with all internal audit controls and develops billing best practices.

• Ensure compliance with all State and Federal regulations.

What You Will Need:

• Bachelor's degree from four-year College, university or equivalent combination of education and experience.

• 7+ years’ experience working in a position of a health care provider, organization, vendor or another consulting firm

What Would Be Nice To Have:

• Understand, write, develop bridge routines/claim mapping.

• Compliance knowledge, UB04, billing editor functions

• Knowledge of clearinghouse and claims submission processes.

• Knowledge of 837 loop and segments

• Knowledge of Coding & CPT (or experience)

• A/P (claims) process

• Worked with claims editors

• Healthcare application product experience

• High level of proficiency required within the MS Office Professional Suite: Word, Excel and PowerPoint.

• Has been part of an implementation team of at least one Healthcare application.

• Clinical experience is a plus.

• Manages processes

• Self starter, good initiative and self starter

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The annual salary range for this position is $87,100.00-$130,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

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