Medical Billing Manager

About us

Project Vision Hawai‘i provides services (health screenings, vaccines, hearing and vision screening, diabetic retinopathy exams, vision exams, street medicine, as well as case management, CIS, housing, SNAP, and health insurance application assistance) in communities with significant access-to-care challenges related to income, lack of insurance, geographical location, or cultural conflict.

About the job

We are a rapidly growing non-profit seeking an experienced, qualified, and dedicated medical billing manager who knows how to navigate the Hawaiian health insurance "world" (including working with local, state, and federal government grants and contracts) to join our 'ohana. In this position, you will be responsible for a variety of tasks requiring data analysis, in-depth evaluation, the ability to negotiate contracts, and sound judgment. As our medical billing specialist, your daily duties will include negotiating contracts with insurers, maintaining billing/coding in our EHR's RCM systems, appealing denied claims, and recording late payments.

Bonus if you are an individual who is knowledgeable in credentialing providers (MD/DO, DDS, APRN, MSW/LCXW, OT, and D.Ac/L.Ac)!

To succeed in this role, you must possess in-depth knowledge of Hawaii's current payors, negotiating contracts, billing, coding, and medical insurance policies. The ideal candidate can forecast earnings, troubleshoot, be innovative and flexible, and is comfortable with building new systems. You must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents will form a large part of the job.

Core Functions/Duties include:

• Coordinate and direct the activities of the billing operations to follow departmental protocol and comply with State, Federal, and payer requirements, guidelines, and regulations.
• Design, execute, and ensure policies and procedures are adhered to, as well as fine-tuning effective billing/intake processes for improvement.
• Plan and direct workload coding, patient insurance documentation, data processing, and billing and collection to achieve efficient account collection and accurate billing.
• Negotiate, analyze, and prepare insurance contracts.
• Analyze weekly and monthly financial reports, as well as accounts receivable reports for ED and board meetings.
• Supervise, train, and mentor the medical billing team; allocate work hours and resolve issues.
• Perform as a practice expert on all issues related to billing and intake processes.
• Prepare to set up a payment system and track clients' AR productivity (charge, payments, collections, adjustments) on a daily, weekly, and/or monthly basis.
• Oversee, evaluate, and monitor on-the-job performance of staff responsible for medical collections.
• Support the company's objective of efficiently and effectively providing management with oversight of the revenue cycle process.
• Over
• Expert knowledge of ICD-9, ICD-10, and CPT codes
• QC charts to ensure codes are assigned correctly and sequenced appropriately per government and insurance regulations.
• Review patient charts and documents for verification and accuracy in EHR
• Follow up and clarify any information that is not clear to other staff members.
• Conduct duties in a professional and timely fashion

If experienced in credentialing:

• Create policies and procedures for credentialing.
• Gather, review, complete, and upload all required credentialing documentation and file accordingly
• Review credentialing application for completeness, log, and request missing documentation
• Perform background checks
• Upload and track compliance items in the appropriate client portal
• Maintain files for any upcoming expiring documents
• Train staff members who can learn to do credentialing.

Education and Experience

• Minimum requirement of an associate degree or higher
• Minimum of 5 years of experience in medical billing management in Hawaii
• Possess profound knowledge and understanding of rules and regulations affecting medical billing and insurance verification.
• Deep knowledge and understanding of revenue cycle, collections, payment posting, medical billing, Medicare and Medicaid, Conduent, and third-party payers.
• Knowledge and understanding of revenue cycles working with grants and contracts.
• Thorough knowledge of CPT and ECD9 codes, UB04 claim forms, HCFA 1500, HIPAA, medical terminology, appeal processes, billing and insurance regulations, and insurance benefits.
• Strong negotiation skills to effectively deal with customers and payers to secure payment.
• Strong proficiency in the use of Word, Outlook, Excel, and other Microsoft Office tools.
• Minimum 1 year of credentialing experience
• Proficient in electronic health records
• Excellent written and verbal communication skills
• Computer skills necessary for data entry and reporting, including typing speed and accuracy
• A strong understanding of medical billing contracts
• Ability to maintain a high level of integrity and confidentiality
• Strict attention to details
• Work independently
• Multitask