My Mountain Mover is hiring a
Medical Subject Matter Expert/Facilitator

Summary

The job is for a Medical Course Development Associate with 3+ years of experience in medical billing. The role involves overseeing the planning, execution, and optimization of medical course development operations particularly in the billing aspect. The position requires a strong background in both healthcare and educational program management.

Requirements

• 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
• Proficiency in utilizing industry-standard billing software, Electronic Health Records (EHRs), and other healthcare management systems
• Strong understanding of healthcare compliance, including HIPAA, and other relevant regulations
• Exceptional communication and interpersonal skills, with the ability to effectively educate and articulate complex billing concepts to diverse audiences
• Demonstrated ability to manage time efficiently, set priorities, and meet deadlines in a fast-paced healthcare environment

Responsibilities

• 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
• Accurately assign diagnosis codes (ICD-10) to represent patient conditions
• Code procedures (CPT) and supplies (HCPCS) with precision
• Determine the need for pre-authorization based on specific procedures
• Communicate with healthcare providers to obtain necessary pre-authorization
• 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
• Analyze denied claims to identify root causes
• Prepare detailed appeal letters with supporting documentation
• Monitor and track the status of appealed claims
• Reconcile payments received with billed amounts
• Investigate and resolve discrepancies in payments
• 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
• Maintain documentation for compliance audits
• Ensure that billing practices adhere to HIPAA regulations
• Stay updated on compliance changes and implement necessary adjustments
• 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
• Investigate and resolve outstanding issues related to rejected or pending claims
• Collaborate with payers and internal teams to address and resolve complex billing issues
• Integrate billing software with electronic health records (EHR) for seamless data exchange
• Optimize software settings for maximum efficiency and accuracy
• 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
• Complete and submit applications for provider enrollment with insurance plans
• Track the progress of provider credentialing and address any outstanding requirements
• Identify bottlenecks in billing workflows and propose improvements
• Implement automation where possible to streamline repetitive tasks

Benefits

• 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