Medical Subject Matter Expert/Facilitator - Billing

We want you, please walk through the job details and fill out the MMM Application Form to proceed:

WHAT WE CAN OFFER:

• Great company culture!
• A lot of opportunity for growth and development!
• Monthly basic salary is between $1100 to $1200 per month
• Permanent Work-From-Home opportunity
• HMO and Dependent Coverage
• Paid US Holidays
• Paid Time Off 
• Free HIPAA Certification
• Incentives e.g. performance incentives, referral bonuses, and attendance incentives

POSITION OVERVIEW:

We are seeking a highly skilled and motivated individual to join our team as a Medical Course Development Associate expert in Billing. The successful candidate will play a crucial role in overseeing the planning, execution, and optimization of our medical course development operations particularly in the billing aspect. This position requires a strong background in both healthcare and educational program management.

QUALIFICATION AND SKILLS:

• College Graduate (preferably a Medical Science grad or BS Accountancy graduate is a plus)
• 3+ years of hands-on experience in medical billing within diverse healthcare settings. 
• Must be highly detail-oriented and organized
• Ability to understand organizational priorities and meet deadlines
• Ability to act and operate independently with minimal daily direction from manager/supervisor to accomplish objectives
• Familiarity with educational technology, instructional design, or related fields
• Experience and knowledge in Salesforce and different platforms for virtual learning
• Communication skills – ability to express ideas clearly and concisely, in writing and verbally.
• Interpersonal skills – cooperative, courteous, flexible and good natured.
• Effective work skills – conscientious, persistent, resourceful, productive and active.
• Knowledge of HIPAA and how US Healthcare Industry works

• Values teamwork
• Takes initiative and has a high sense of accountability
• Ability to work cooperatively and collaboratively with all levels of independent contractors and management 
• Knowledge in Medical Terminologies or with Medical Background is a plus

TOP 5 NON NEGOTIABLE

1. 3+ years of hands-on experience in medical billing within diverse healthcare settings. In-depth knowledge and expertise in medical billing practices, including CPT, ICD-10, HCPCS, and payer regulations, Comprehensive understanding of healthcare revenue cycle management.

2. Proficiency in utilizing industry-standard billing software, Electronic Health Records (EHRs), and other healthcare management systems.

3. Strong understanding of healthcare compliance, including HIPAA, and other relevant regulations, with demonstrated experience ensuring billing practices adhere to legal and ethical standards.

4. Exceptional communication and interpersonal skills, with the ability to effectively educate and articulate complex billing concepts to diverse audiences, including clients, co-workers, VAs and healthcare professionals.

5. Demonstrated ability to manage time efficiently, set priorities, and meet deadlines in a fast-paced healthcare environment.

RESPONSIBILITIES:

Demographic and Insurance Information:
Collect and verify patient names, addresses, and contact details.
Validate insurance ID, group numbers, and policyholder information.
Confirm and update any changes in patient information and insurance coverage.


ICD-10, CPT, and HCPCS Coding:
Accurately assign diagnosis codes (ICD-10) to represent patient conditions.
Code procedures (CPT) and supplies (HCPCS) with precision.
Validate codes against documentation to ensure accuracy.


Pre-authorization and Pre-certification:
Determine the need for pre-authorization based on specific procedures.
Communicate with healthcare providers to obtain necessary pre-authorization.
Document and track pre-authorization status for claims processing.


Claim Scrubbing and Submission:
Utilize claim scrubbing tools to identify and correct errors before submission.
Submit claims electronically using established billing systems.
Monitor and confirm successful claim transmission to payers.


Denial Analysis and Appeals:
Analyze denied claims to identify root causes.
Prepare detailed appeal letters with supporting documentation.
Monitor and track the status of appealed claims.


Payment Reconciliation:
Reconcile payments received with billed amounts.
Investigate and resolve discrepancies in payments.
Apply adjustments and refunds accurately.


Patient Billing and Financial Counseling:
Generate and send itemized bills to patients.
Provide financial counseling to patients, explaining billing details and payment options.
Establish and manage payment plans in accordance with organizational policies.


Compliance Documentation:
Maintain documentation for compliance audits.
Ensure that billing practices adhere to HIPAA regulations.
Stay updated on compliance changes and implement necessary adjustments.


Audit Trail and Reporting:
Maintain a comprehensive audit trail for all billing activities.
Generate detailed reports on billing metrics, including claim acceptance rates and denial trends.
Provide regular reports to management for performance evaluation.


Follow-up on Unresolved Issues:
Investigate and resolve outstanding issues related to rejected or pending claims.
Collaborate with payers and internal teams to address and resolve complex billing issues.


Technology Integration and Optimization:
Integrate billing software with electronic health records (EHR) for seamless data exchange.
Optimize software settings for maximum efficiency and accuracy.

Training and Cross-functional Collaboration:
Conduct regular training sessions for staff on updated billing processes.
Collaborate with coding teams, front office staff, and providers to improve overall revenue cycle management.

Provider Enrollment and Credentialing:
Complete and submit applications for provider enrollment with insurance plans.
Track the progress of provider credentialing and address any outstanding requirements.

Workflow Efficiency Enhancements:
Identify bottlenecks in billing workflows and propose improvements.
Implement automation where possible to streamline repetitive tasks.
Assist and take over some daily L&D processes after 30-60-90 days training (skills profiling, mock interviews, department introduction, MLC exam application, L&D Scorecard)