Medical Billing Collection Manager

5+ years

Not Disclosed

Lexington

10 Nov. 23, 2024

Job Description

Job Type: Full Time Education: B.Sc./M.Sc./B.Pharm/M.Pharm/Life science/MBA Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Job Title: Collections Manager / Medical Billing Specialist

Pay Rate: $90,000 - $110,000 per year
Duration: Direct Hire
Location: Lexington, MA 02421

Major Duties and Responsibilities

Billing and Compliance

Ensure billing processes comply with payer requirements for Government, Commercial Health Plans, and Medical Group payers.
Verify accurate coding and units per payer and therapy type.
Prepare accurate claims submissions, meeting all payer requirements, via electronic or hard copy methods.
Assure necessary authorizations and medical documentation accompany claims for prompt processing.

Claims Management

Analyze and resolve claim issues with payers through timely follow-up on claim status and payments.
Ensure claims are processed and paid fully according to contractual agreements.
Record revenue appropriately based on contract terms.

Communication and Coordination

Communicate effectively with branches, departments, and management to resolve reimbursement issues promptly.
Conduct collection calls to payers or patients in a professional manner.
Escalate reimbursement challenges to management when necessary.

Compliance and Documentation

Protect patient health information by adhering to HIPAA regulations.
Maintain thorough and accurate records of billing and collection activities.

Productivity and Goal Achievement

Prioritize and multitask effectively to meet daily productivity targets and monthly closing goals.
Proactively suggest and implement process improvements to enhance efficiency.

Education and Experience

Education:
- Bachelor’s degree in business or a related field, or equivalent education and experience.
Experience:
- Minimum of 5 years (excluding school or externship) in Home Infusion.
- Proficient understanding of HCPC and CPT codes.
- Knowledge of insurance terms, medical terminology, and pricing methodologies for commercial and government billing.
- Strong computer skills, including proficiency in Microsoft Word and Excel.

Interpersonal Relations and Teamwork

Demonstrate positive interpersonal relations with supervisors, co-workers, and other employees to maximize productivity and positive relations.
Exhibit a positive attitude toward the organization, job, and colleagues.
Treat others with respect and sensitivity, promoting a culture of compassion and responsiveness.
Embrace and suggest changes to improve workflows and processes.
Maintain confidentiality and comply with company policies, including those in the employee handbook and quality/safety guidelines.

Equal Employment Opportunity Statement

Suna Solutions is an equal opportunity employer, prohibiting discrimination and harassment based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

This policy applies to all aspects of employment, including recruiting, hiring, promotion, termination, compensation, and training.

Applicants with criminal histories will be considered consistent with local, state, and federal laws.

Accommodations

Suna Solutions is committed to providing accommodations for persons with disabilities or religious observances. If hired, accommodations for essential functions will be determined through a reasonable accommodation process.

For recruiting-related accommodations, call 1 (888) 223-4788 or email Suna Solutions.

Pay Transparency Policy Statement

Compensation varies based on factors such as the specific client, location, role, skills, and experience. For roles in California, Colorado, New York City, or Washington, Suna Solutions provides reasonable pay scales in compliance with local law.

This structured layout improves readability and organizes the job details for clarity.

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