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Date: Jan 1, 2019

Location: Irvine, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

Job Summary:
The Medical Billing Manager performs and oversees medical billing functions for all of the physicians managed by PersonalCare. This includes but is not limited reviewing claims, following up with physicians as needed to update/correct claims, submitting claims, receiving payments, following up with insurance companies on outstanding or unpaid claims, creating/sending statements to patients, and collecting payments from patients. In addition, the Medical Billing Manager is responsible for initial and ongoing credentialing for all providers including maintenance of CAQH records. The Medical Billing Manager directs the work of others who participate in the medical billing process including contracted labor and employees.


• Medical Billing
o Review all claims submitted by the physicians in the EMR for accuracy and proper coding, following ICD-10 protocol
o Work closely with physicians to update and correct claims as necessary to ensure payment is received in a timely manner
o Receive, review, and post all insurance payments and patient payments
o Follow-up with insurance companies and patients as needed to determine the status of outstanding claims and collect payments
o Manage the insurance denial process including re-submitting corrected claims, contacting insurance companies to determine the reason for denials, and submitting patient records as needed to get claims paid
o Review and send patient statements monthly; work with physicians as needed to ensure accuracy of statements
o Post and reconcile payments in both the EMR and ERP systems
• Medical Billing Advisory Services
o Prepare weekly reports for the medical groups to provide a current snapshot of performance in medical billing
o Prepare monthly reports to show all billing for the period including which codes were billed and what was collected
o Attend physician meetings, as requested by the medical groups, to review billing trends and discuss best practices
o Provide cheat sheets or other tools, as requested by the medical groups, to ensure accuracy and consistency of billing
• Credentialing
o Perform initial credentialing for new physicians added
o Provide support for ongoing credentialing, as requested by the physicians
o Maintain up-to-date CAQH records for each physician
o Review and advise on requests to add additional insurance companies/plans, as requested by the medical groups



• 5+ years of experience in Medical Billing, preferably in a supervisory role
• Experience in and knowledge of all medical billing protocols including HCPCS, ICD-10, and CPT codes
• EMR system experience, preferably with both eClinicalWorks and AllScripts
• Knowledge of and experience with adhering to all HIPAA regulations



• Proficiency in self-management; ability to set and meet/exceed goals for the medical billing department
• Ability to work as a member of a team and lead others
• Effective communication skills (oral and written); excellent phone etiquette and ability to maintain strict HIPAA compliance
• Demonstrated ability to handle multiple assignments and to collaborate effectively across an organization
• Proven attention to detail with maximum accuracy; strong analytical skills to determine best coding practices
• Strong Microsoft Office skills (especially Excel); EMR system experience; Sage 300 ERP experience is a plus
• Ability to maintain professional demeanor at all times and to exercise good judgement in working with patients and physicians

Nearest Major Market: Irvine California
Nearest Secondary Market: Los Angeles

Job Segment: Accounts Receivable, Manager, ERP, Finance, Management, Technology

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