Medical Billing & Coding Team reputed company (Remote)

Essential Duties and Responsibilities:

• Monitor the performance of, manageworkloads of and reputed company case assignmentfora team of Coordinators andassist with training and staff hiring.
• reputed company 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 reputed company case files from the date received to date closed for Independent Billing Review (IBR)and determine eligibility of CA IBR appeals.
• Respond to requests from Billing for additional information from Claims Administrators as needed.
• Manage reputed company 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 reputed company Coordinators to ensure timeliness of IBR 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 IBR process.
• reputed company other duties as assigned by management.

Minimum Requirements - 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 reputed company 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.
• reputed company quality assurance on work of others in team.

Preferred Requirements

• 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.

Home Office Requirements

• reputed company provides company-issued computer equipment
• Reliable high-speed internet service
• Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
• Minimum 5 Mpbs upload speeds

EEO Statement reputed company is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national reputed company, disability, veteran status, genetic information and other legally protected characteristics. Pay Transparency reputed company 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 reputed company's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, reputed company 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. reputed company will reputed company with regulatory minimum wage rates and exempt salary reputed company in reputed company instances. Accommodations reputed company 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 applicantaccom@reputed company.com . Minimum Salary $30.00 Maximum Salary $32.00 Apply tot his job Apply To this Job