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

Purpose of the Job:  Seeking an experienced Medical Billing Specialist in our nonprofit division. A self-starter who will take on responsibilities for submitting clean claims to commercial/private insurance companies, Medicaid/MCOs, and health and human service clients.

Basic Function: Strong background in medical billing, with the skills necessary to improve our current billing procedures and reduce A/R days. The successful applicant will work on multiple tasks requiring data analysis, in-depth evaluation and exercising judgment within the appropriate scope of practice.

Key Result Areas (Principal Accountabilities) :

• 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

Requirements

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

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

Benefits

Working Days : Monday - Friday

Working Hours – 9 hours (US work Shift Pattern), Hybrid - mix of WFO and WFH. The working hours may get extended due to nature of the business.

 The employee must be willing to work at a location in a small-to mid-sized office setting, plus attend client conferences and meetings that may or may not be held during the workday. Travel to other Quatrro locations or client offices may be necessary, as well as physical presence at company meetings with other offices throughout the globe.