Job Description

Company Overview

We are a healthcare organization dedicated to improving the management of chronic diseases through our Unified Care program. Our focus is on delivering Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) services. We provide support to patients at home between doctor’s appointments to help them achieve better health outcomes. Our comprehensive services also include Medical Nutrition Therapy (MNT) to address the nutritional needs of patients.

Job Summary

We are seeking a highly skilled Medical Billing Specialist to manage and oversee our billing and revenue cycle processes. This role will focus on ensuring timely and accurate billing for Remote Patient Monitoring, Chronic Care Management, and Medical Nutrition Therapy services. You will be responsible for managing the complete billing workflow, from validating claims and following up on denials to generating revenue reports. The ideal candidate will have extensive experience in medical billing, a deep understanding of coding practices, and the ability to identify and implement strategies to enhance revenue capture.

Responsibilities and Duties

• Manage the end-to-end billing process for RPM, CCM, and MNT services, including charge entry, claims submission, and payment posting.
• Validate patient benefits and verify insurance eligibility by contacting insurance providers.
• Ensure compliance with all Medicare, State programs, HMO/PPO regulations and guidelines.
• Conduct thorough follow-ups with insurance companies to resolve outstanding claims and denials, ensuring prompt resubmission and appeals.
• Analyze revenue reports, identify trends related to errors, and work to improve revenue cycle performance.
• Collaborate with internal teams, particularly IT, to streamline billing workflows and enhance system efficiencies.
• Prepare and analyze reports for key stakeholders, highlighting financial health and opportunities for growth.
• Perform audits on billing records and rectify discrepancies to maintain accuracy.
• Conduct training sessions for internal teams and external stakeholders on billing processes and protocols.
• Implement strategies to improve claim acceptance rates, reduce denials, and enhance the overall billing experience.
• Maintain organized documentation of all billing activities, including invoicing, payments, and follow-ups on overdue payments.
• Ensure HIPAA compliance throughout the billing process.
• Monitor and stay current on changes in healthcare billing and coding regulations.

Qualifications and Skills

• Minimum Qualifications:

• Bachelor’s degree in Accounting, Healthcare Administration, Finance, Business, or a related field.
• 8+ years of experience in a healthcare billing or related field.
• Strong knowledge of CPT, ICD-10, HCPCS codes, and experience using EHR systems like EPIC, Kareo, eCW, Athena, and others.
• Proficiency in medical terminology and insurance plans.

• Preferred Qualifications:

• Certification in Healthcare Billing and Management.
• Experience in payer policy guideline analysis and managing complex billing scenarios.
• Strong problem-solving skills with a focus on strategic revenue management.

Benefits and Perks

• Competitive salary and performance-based bonuses.
• Health, dental, and vision insurance.
• Opportunities for professional development and certifications in medical billing and coding.
• Flexible work schedule with potential for remote work.
• Access to state-of-the-art healthcare software and technology.
• Collaborative and supportive work environment focused on employee growth.

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