Billing and Coding Manager

March 21

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Balance Health

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Balance Health is the nation’s premier comprehensive lower-extremity focused Physician Practice, having formed the largest majority physician-owned podiatric medical organization in the United States through its merger with Weil Foot & Ankle Institute. It offers operational support to podiatrists, orthopedic surgeons, and physical therapists, allowing them to concentrate on delivering high-quality patient care and growing their practices. Balance Health aids in recruiting, HR billing and collections, accounting, technology, marketing, regulatory compliance, and more, catering to private practice needs. Moreover, Balance Health provides partners access to ancillary services such as pathology labs, MRIs, physical therapy services, and orthotic labs, which contribute to convenient patient care and additional revenue streams. By leveraging its size to enhance contracts and decrease costs, it supports value-based care while promoting clinical autonomy for its physicians, making it a dynamic partner for medical professionals committed to providing exceptional foot and ankle care.

podiatry • lower extremity • foot and ankle care

51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

📋 Description

• Contributes to the company’s mission, vision and values by developing and managing the billing and coding processes. • Implements improvements to the billing and collections activities and ensures revenue cycle compliance. • Responsible for communication with clinicians, management and operation teams, and RCM department on a regular basis. • Crucial in ensuring the accuracy and efficiency of coding processes, compliance, and education. • Leads a proficient billing/collections team, managing daily operations of the department, developing complex billing processes, and optimizing workflows. • Serves as a resource for healthcare providers and staff on billing and coding issues, offering guidance and solutions. • Provides direction to the RCM team regarding billing operations, billing and collection, coding and compliance, reimbursement and third-party contract compliance, and reporting. • Coordinates with employees responsible for charge capture or entry, coding, reimbursement, or insurance verification to identify and resolve issues impacting billing or collections. • Manages daily operations of the coding department, ensuring accurate and timely preparation and submission of claims. • Monitors, assesses and manages daily production. • Ensures compliance with all relevant reporting and data collection regulations. • Tracks metrics to develop and implement strategies for improvement. • Manages the policies, objectives, and initiatives of RCM activities to meet target operational and revenue goals. • Provides training and education relative to regulatory and billing requirements. • Oversees coding compliance and develops coding/billing protocols. • Designs and develops billing/coding training modules, instructing current coders and coder trainees about coding guidelines, code changes and observed issues from audits. • Manages an onshore and offshore billing and coding team.

🎯 Requirements

• Podiatry experience preferred. • Certified Professional Coder (CPC) certification is required. • Must communicate logically and clearly both orally and in writing. • Minimum of 5 years’ experience interpreting insurance explanation of benefits. • Minimum of 3 years’ experience with medical claims, billing, payment posting and insurance collections. • Extensive knowledge of ICD-10-CM and AMA CPT coding is required. • Knowledge of all insurance guidelines especially Medicare and Medicaid according to standards. • Knowledge of California payors, including IPAs is a plus. • Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation. • Experience with prior authorizations, pre-determinations, and out-of-network gap exceptions. • Ability to supervise and mentor others. • Ability to use independent judgment and to manage and impart confidential information. • Excellent analytical and communication skills. • Strong research skills including knowledge of automated analysis tools is required to resolve complex coding/systems issues. • Legal eligibility to work in the United States without sponsorship now or in the future. • Ability to successfully pass a background investigation / pre-employment screening.