Medical Billing Manager

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Here at Clinical Care Medical Centers, we are in need of a Billing Manager with in-depth knowledge of Procedural Coding, identifying appropriate ICD-10 coding based on CMS/HCC categories, CPT, HCPCS CMS 1500 FORM, HEDIS, MRA, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB and payments, denials and appeals, Billing, Collections and Appeals processes, and Medicare and Medicare Advantage billing methodology and processes.

• Certified Professional Coder certification
• Bi‑lingual English/Spanish preferred; must be able to read, write and speak English.
• 3+ years of experience managing a Medical Billing Department.
• Moderate computer knowledge: MS Word, MS Excel, internet, EHR systems, document management, e‑faxes and email.
• Strong people skills; independent decision making and customer service oriented.
• Strong organizational skills.
• Credentialing experience preferred.

• Review medical records to identify appropriate ICD‑10 coding based on CMS/HCC categories for billing purposes.
• Create and submit insurance claims to different insurance companies.
• Process patients’ billing and statements, reimbursement claims, post transactions and data.
• Document appeals based on insurance denials.
• Communicate with insurance compliance for claim payment/rejections.
• Submit doctor credentialing applications to insurance companies and hospitals.
• Collect patient payments by mail or telephone and ensure payments are recorded and processed.
• Assist Practice Administrator in updating practice or doctor licenses and distributing HEDIS/MRA reports.
• Assist in balancing copays and insurance payments for service facilities.
• Transmit financial reports to accountant.
• Review accounts receivable regularly and take necessary collection action.
• Ensure HEDIS claims tracking and reporting.
• Post payments via ERA and manual posting for Medicare, Medicaid, and third‑party payers.
• Review accounts for possible assignment and recommend to practice administrator.
• Perform other duties as assigned.

At Clinical Care Medical Centers, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and employees without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military and veteran status, and any other characteristic protected by applicable law.

Clinical Care Medical Centers believes that diversity and inclusion among our employees is critical to our success as a company. We support an inclusive workplace where employees excel based on personal merit, qualifications, experience, ability, and job performance.