Medical Billing and Coding

• Identify, prospect, and generate new business opportunities across the United States
• Target physicians, physician groups, hospitals, specialty clinics, urgent care centers, ambulatory surgery centers, behavioral health providers, dental practices, and other healthcare organizations
• Develop and execute targeted sales strategies to achieve monthly, quarterly, and annual revenue targets
• Drive new client acquisition, market penetration, account growth, and expansion of Amtrix Healthcare’s US presence
• Build and manage a sales pipeline through cold calling, email campaigns, LinkedIn outreach, referrals, networking, industry associations, webinars, conferences, and other business-development channels
• Research and qualify prospects based on practice size, specialty, payer mix, billing volume, current RCM model, technology stack, operational challenges, and outsourcing needs
• Conduct discovery calls and needs assessments with healthcare decision-makers
• Identify client pain points and understand existing revenue cycle processes
• Present customized RCM solutions based on prospective clients’ business and operational requirements
• Manage opportunities through the sales cycle from prospecting and qualification through closure and account growth

Healthcare RCM Sales Executive – Medical Billing

• Oversee adherence to the Company’s compliance program using OIG Compliance Program Guidance for Third-Party Medical Billing Companies
• Assist the General Counsel in implementing and leading the Company’s compliance committee
• Improve efficiency and quality of services and reduce vulnerability to fraud, abuse, waste, and other risks
• Investigate, review, and respond to compliance issues, concerns, and complaints
• Review governmental health plan publications and arrange training about relevant changes
• Revise the compliance program in light of changes in company needs, laws, and payer policies
• Review employee certifications and standards-of-conduct compliance
• Develop, coordinate, and participate in compliance education and training programs
• Coordinate personnel and provider screening against the Cumulative Sanction Report
• Coordinate internal compliance reviews and monitor departmental activities
• Design and coordinate internal investigations and corrective actions
• Develop policies encouraging reporting of suspected fraud and improprieties without retaliation
• Process Medicare pre- and post-payment audits
• Process patient complaints and disputes involving possible compliance or provider service problems
• Research and develop answers to coding or billing situations with the Vice President of Strategy and Integrity
• Establish and perform internal reimbursement-coding audits
• Report internal audit findings to leadership bi-monthly
• Track error rates and ensure improvement or outline further steps
• Provide pertinent new and deleted CPT code lists for client fee schedule updates
• Troubleshoot coding issues for business associates and internal personnel
• Communicate with payers regarding prepayment review resolution
• Review accounts and determine resolution methods for prepayment reviews
• Provide quarterly compliance training on new issues and identified deficiencies
• Assist with training and troubleshooting for payment deficiencies
• Manage payer appeals specialist

Medical Billing Compliance Manager

• Complete approximately 20 weeks of online classroom training
• Complete approximately 19 weeks of online internship training
• Learn CPT, ICD-10-CM, and HCPCS Level II code sets
• Support provider credentialing, recredentialing, payer enrollment, and provider network participation activities
• Verify documentation and manage provider data
• Prepare, submit, and process claims and payments
• Provide accurate support for provider credentialing and enrollment requirements
• Research and obtain provider or clinic information through Epic in-basket communication
• Review and organize payer-enrollment documents, including hospital affiliations and collaborative agreements
• Validate and maintain provider information in MD Staff and CAQH
• Assist with credential updates and data consistency across systems
• Participate in practitioner-file audits and data-integrity projects
• Collaborate with health centers, providers, internal teams, OBS, payers, clients, and other stakeholders
• Identify enrollment delays and reinforce best practices
• Maintain HIPAA confidentiality
• Perform data entry and computer-based project tasks
• Meet assigned productivity goals and perform other duties as assigned

Medical Billing and Coding Training Program – Credentialing and Enrollment Internship

• Complete approximately 20 weeks of online classroom training
• Complete approximately 19 weeks of online internship/remote hands-on training
• Learn health insurance, healthcare settings, medical coding, reimbursement, billing, legal and regulatory issues, and claim processing
• Prepare for AAPC CPB and CPC certification exams
• Provide coding services in accordance with payer requirements, organizational policies, and coding guidelines
• Abstract diagnoses and procedures from patient medical records and online patient data
• Review patient encounters and accurately assign diagnosis and procedure codes
• Research provider or office information through Epic in-basket when necessary
• Assist with denied-claim research
• Meet assigned productivity goals
• Provide accounts receivable services and maximize reimbursement
• Bill Medicare, Medicaid, self-pay/uninsured, and commercial insurance claims
• Monitor receivables, check claim status, resubmit overdue claims, file corrected claims or appeals, and escalate seriously overdue accounts
• Post patient payments, electronic remits, and paper EOBs
• Correct claim and charge errors and resolve credit balances
• Answer patient and responsible-party calls regarding account balances
• Maintain patient and organizational data confidentiality in compliance with HIPAA
• Perform billing, data-entry, computer-operations, and other assigned projects

Medical Billing and Coding Training Program

• Convert diagnoses and procedures for emergency and outpatient cases into accurate and timely ICD-10, CPT, and HCPCS codes
• Understand the clinical content of health records
• Use an EHR system and encoder to perform coding duties
• Abstract demographic and physician data for internal and regulatory reporting
• Use the hospital’s abstracting system
• Follow American Hospital Association Coding Clinic, ICD, CMS, HCAI, and NorthBay Health coding rules, regulations, conventions, and guidelines
• Meet trained performance metrics and monitored idle-time expectations
• Participate in frequent webcam-based team engagement

Medical Billing and Coding jobs in California

Healthcare RCM Sales Executive – Medical Billing

Medical Billing Compliance Manager

Medical Billing and Coding Training Program – Credentialing and Enrollment Internship

Medical Billing and Coding Training Program

Health Information Management Coder I