Medical Billing & Coding Team Lead; Remote

Essential Duties and Responsibilities

• Monitor the performance of, manage workloads of and perform case assignment for a team of Coordinators and assist with training and staff hiring.
• Develop and maintain processes and procedures at the direction of the director, liaison with Project Directors regarding procedural issues, and communicate with the CA Division of Workers' Compensation (DWC) regarding policy and eligibility issues.
• Manage complex case files from the date received to date closed for Independent Billing Review (I ) and determine eligibility of CA I  appeals.
• Respond to requests from Billing for additional information from Claims Administrators as needed.
• Manage complex case files from date received to date closed.
• Determine eligibility of appeals and submit potentially ineligible cases to the CA DWC for final eligibility determination.
• Request additional information from Claims Administrators.
• Draft correspondence regarding eligibility and assignment.
• Manage the workload of all Coordinators to ensure timeliness of I  reviews.
• Collaborate with the client to address policy issues that arise in the content of review.
• Ensure that process is being completed timely according to contract regulations.
• Work with Systems Development staff regarding Entellitrak updates to enhance I  process.
• Perform other duties as assigned by management.

• High School diploma or equivalent or Associate degree with 1.5 - 4 years of experience.
• Additional clinical licensure may be required based on project.
• Additional training or education in area of specialization.
• Works on a variety of assignments requiring considerable judgement and initiative.
• As a skilled and experienced specialist, completes tasks in resourceful and effective ways.
• Able to draft or modify training materials and procedural documentation accurately.
• Skilled in handling challenging communications with external contacts for escalated matters.
• Act independently to determine methods and procedures on new assignments.
• Serves as facilitator and team leader, allocating work and providing guidance and training to others in field of specialization.
• Perform quality assurance on work of others in team.

• Experience with reading and reviewing Explanation of Reviews
• Explanation of Benefits, Remittance Advice, or similar payor issued documents.
• Experience in billing and or coding medical claims.
• Experience with Health Plans, as a claims examiner processing medical claims.
• Familiarity with Medical Claim Forms and CPT, HCPCS, ICD-10-CM codes.
• Experience with Medical Claim Appeal Processes, appealing and receiving / reviewing appeals.

• Maximus provides company‑issued computer equipment
• Reliable high‑speed internet service
• Minimum 20 Mbps download speeds / 50 Mbps for shared internet connectivity
• Minimum 5 Mbps upload speeds

LI-Remote

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long‑term incentives as well as program‑specific awards.

Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Maximus provides reasonable accommodations to individuals requiring assistance during any phase of the employment process due to a disability, medical condition, or physical or mental impairment. If you require assistance at any stage of the employment process—including accessing job postings, completing assessments, or participating in interviews—please contact People Operations at

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