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Billing Operations Manager
Location: US-NY-Orchard Park
Jobcode: fd24cd17-b2c3-4ca6-963a-ff613e2d4887
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Client is a highly successful Ophthalmology Group with 4 locations located in the Buffalo, NY, area.
Responsibilities:
- The timely preparation and filing of insurance claims (paper and electronic claims transmission), insurance aging reports, and prior approvals.
- The timely review and follow up on all claims and collection of insurance claims and patient accounts.
- Play an active role in the coding process for medical claims and provider credentialing.
Essential Skills and Abilities:
Billing Operations:
- Strong knowledge of CPT and Diagnosis Coding
- Credentialing Experience
- Effective Leadership Skills
- String knowledge of medical insurance, payments and deductibles
- Computer literate with spreadsheet and MS Office.
- Strong mathematical and financial management skills.
- Working knowledge of standard accounting principles..
- Ability to manage staff
- Audits - Prepare responses to all insurance company requests and audits, including provider incentive programs. Conducts Periodic internal chart audits.
Personnel Management:
- Perform annual performance evaluations on all departmental staff and meet with the Administrator to discuss employee performance.
- Hold staff accountable for accuracy and appropriateness.
- Train new departmental staff members.
Credentialing:
- Oversee all credentialing for new doctors and/or any renewals with regards to both insurance and hospital requirements.
- Create and update all physicians on Council for Affordable Quality Healthcare (CAQH) and Provider Enrollment Chain & Ownership System (PECOS) website.
Payer and Medical Organization Relations:
- Maintains appropriate relationships with all insurance provider representatives.
- Maintains communications with all necessary MLMIC representatives and Medical organizations regarding patient care and physician/patient relations.
Qualifications:
- Associates Degree or higher desired.
- High school diploma or equivalent required.
- At least 5 years of previous medical office billing experience.
- Medical Coding Experience Desired.
- Ophthalmology Experience.
- Certification in Ophthalmology Coding preferred.
- Nextech EHR Experience.
- Strong computer background.
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