3 Billing Regulations Jobs

You will be responsible for serving as an AR/Denial Specialist, ensuring adherence to billing regulations and compliance requirements. Additionally, you will be tasked with developing and executing strategies aimed at enhancing revenue cycle efficiency and effectiveness. Regular audits will need to be conducted to verify the accuracy and compliance of billing processes. Providing training and continuous support to junior associates and team members will also be part of your responsibilities. Collaboration with leadership is key to developing and monitoring key performance indicators. It is essential to stay updated on industry trends and best practices in revenue cycle management. To qualify for this role, you must possess a Bachelor's degree in healthcare administration, finance, or a related field. A minimum of 5 years of progressive experience in medical billing or revenue cycle management is required. In-depth knowledge of healthcare billing regulations and compliance standards is crucial. Strong leadership and mentoring skills are necessary for this position. Excellent communication and presentation abilities are also essential. Proficiency in data analysis and reporting tools is a must, along with the ability to drive change and implement process improvements effectively. Qualifacts is an equal opportunity employer that values diversity and is dedicated to fostering an inclusive environment for all employees.,

Job Purpose The Manager, Operations will provide leadership and guidance to offshore RCM Partners and their teams reviewing processes and providing recommendations for improvement of operations working towards our combined operational goal to meet or exceed national AR KPI benchmarks and client specific KPIs. Help support project work for all functions with offshore and ensure they are held to timely completion guidelines. Ensure that offshore partners, maintain or exceed team productivity and quality standards. Work with vice President to understand and communicate the economic impact of upstream revenue cycle errors causing denials and provide data and implement effective processes to correct actions. Duties And Responsibilities Plan, organize and direct overall operations of the Offshore Partners assigned as it relates to RCM and their specific tasks are being worked to completion in a timely manner Work in conjunction with Vice President Revenue Cycle Services to set and manage target performance levels and reduce the offshore staffing to meet the 50 FTE threshold by ensuring all backlogs are moved current Ensure that the team stays current with billing regulations and industry requirements and/or trends and you are updating the pathways, reviewing with the offshore teams, and ensuring the processes are being followed Maintain an overall objective of maximization of cash collections, minimization of A/R inventories, and the minimization of write-offs/non-collectible adjustments Actively engage with and manage AR Follow Up team, including routine productivity and quality reviews Assures that team is meeting follow-up quality and productivity standards Identifies denial trends and makes recommendations for prevention Create a monthly executive QA tracker of offshore performance for all functions being sent to offshore vendors and VP monthly Provide VP bi-weekly status of progress and all trends seen during this time Validate and approve monthly the AR, invoices, and report to VP Create and develop pathways for all functions used offshore by working with the team managers and directors to get them completed Provide management and supervisory duties related to educating and training staff, evaluating staff performance and monitoring productivity Interview, hire, train, evaluate, and develop subordinate staff, where applicable Develop and maintain quality control programs, including in-depth and individual performance reviews Orient new hires and provide in-services and training, continuing education, and development related to those functional areas of responsibility Other duties as assigned Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Qualifications Bachelors degree or equivalent combination of education and experience 5+ years experience managing and leading a physician business office/professional services CBO or MSO staff at a supervisory level or higher Ability to work well individually and in a team environment Must be reliable, responsible, goal oriented and flexible Excellent interpersonal, communication and organizational skills High degree of integrity including ability to successfully deal with sensitive or confidential information Ability to exhibit poise, composure and confidence when confronting stressful or high- pressure situations Working Conditions Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment: The noise level in the work environment is usually minimal. Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law. Show more Show less

As an SME in Denial Management with 2-3 years of experience, you will be a part of Zapare Technologies Pvt. Ltd., a leading provider of Revenue Cycle Management (RCM) solutions for the US Healthcare industry. Your role will involve analyzing, managing, and resolving denied insurance claims to enhance collections and optimize revenue cycles for clients. Your main responsibilities will include developing and maintaining denial logs to identify trends, working with denial reason codes to take appropriate actions, and ensuring compliance with HIPAA, CMS guidelines, and coding standards. You will also manage the appeals process by understanding appeal processes and SOPs, preparing and submitting appeals with accurate documentation, and monitoring deadlines for timely submissions. The ideal candidate will possess a strong understanding of the US healthcare billing cycle, hands-on experience with EMR/EHR systems, in-depth knowledge of billing regulations, coding standards, and compliance frameworks. If you are passionate about healthcare revenue management and proficient in resolving complex denials, we encourage you to apply and be a part of the Zapare team. #Hiring #DenialManagement #RCM #HealthcareJobs #MedicalBilling #RevenueCycleManagement #ZapareTechnologies #CareerOpportunity,