Medical Practice Claims Manager

• Referral bonus opportunities

• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

• Employer-matched 401k retirement saving program and opportunity for both pre- and post-tax contributions

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent careand commuter transit program

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth, career advancementand CEU credits

What You Will Do

• Supervises and trains assigned internal and/or external staff to ensure prompt and accurate completion of billing verification and authorization requests, and cash application to third party payors and governmental agencies and the daily application of payments to open receivables.
• Manages daily cash application of payments made to lockbox.
• Evaluates effectiveness of operational procedures and controls and performs reconciliations to ensure maximization of departmental productivity and minimization of errors. Makes recommendations for improvements, as appropriate.
• Assists in daily and monthly cash reconciliation process.
• Participates in the development of key performance indicators for the cash applications group; monitors performance.
• Analyzes payments on a regular basis and reconciles remittances.
• Issues billing and payment reports and payment data relating to unapplied cash issues.
• Reviews rate updates and billing codes; confirms new rates/billing codes are aligned with the contract and agency billing standards.
• Assists in the implementation of initiatives to minimize verification-related or authorization-related delays to patient care while maximizing collections.
• Schedules daily work assignments of assigned staff and provides guidance and assistance in the resolution of problems.
• Communicates with third party payors and governmental agencies regarding unpaid claims, billing procedures, verifications, authorizations, delinquent accounts, overpayments and refunds where applicable.
• Researches billings rejected by Medicare, Medicaid, and other insurance(s) to determine source of errors. Works unbilled reports to identify and resolve billing related issues.
• Reviews all payment discrepancies and, if necessary, contacts Medicare, Medicaid, and other insurances to resolve discrepancies.
• Verifies accuracy of input of patient visits, charges, and payments.
• Follows up and ensures timely collection of Medicare, Medicaid, and other insurance accounts including outstanding third-party requests from internal departments.
• Assists with the formulation and implementation of new business procedures and interacts with other departments as applicable.
• Supervises filing of Medicare, Medicaid, and other insurance documentation. Follows-up with clinical documentation for re-classing billing and payments.
• In the absence of Revenue Cycle Manager, is responsible for assigned business operations.
• Assists leadership in the coordination and management of administrative matters and office activities.
• Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for employment, evaluates staff performance and recommends hirings, promotions, salary actions and terminations, as appropriate.
• Participates in special projects and performs other duties as assigned.