Billing Manager

Vista Del Mar • Los Angeles, CA

6h

About The Position

The primary responsibility of the Quality, Standards and Compliance Billing Manager is to Oversee contract and client claims submission, funding eligibility and verification, provide supervision and task coordination to Quality, Standards and Compliance Department functions.

Requirements

• Certification of Medical Billing / Health Claims Examiner or one year experience with medical insurance billing. Must be familiar with medical terminology, CPT-4 and ICD-9 coding.
• Detail oriented and organized with strong ability to multitask
• Work cooperatively with others
• Outstanding oral and written communication skills
• Strong knowledge of Microsoft Office Excel and Microsoft Word.
• Experience working with disturbed children

Responsibilities

• Manages projects, data collection and running data repo.
• Manage monthly Third-Party Billing. To include Eligibility verification of insurance benefits and California State Victims of Crime (VOC) Communicate benefit information and insurance requirements accurately to clinicians and clients. Create and maintain client’s insurance record containing demographic information and summary of services related to the client. Monthly submit claims to insurance or State VOC, verify receipt and processing. Review EOBs for accuracy of benefits paid, denied, or unpaid. Enter reconciled claims into the DMH Integrated System (IS). Performs various collection actions including contacting parents/guardians by phone, correcting and resubmitting claims to third party payers. Maintain accounting of claims submitted, received and outstanding.
• Oversee client funding eligibilities and verification documentation for DMH contract, including State Medi-Cal eligibility verification batch files and TIER eligibility and funding screens for OPS clients at admission and monthly thereafter.
• Run, review, and disperse TIER Unit of Service billing reports weekly of all VDM programs for data entry into the DMH IS.
• Run weekly/monthly, or as needed DMH IS UOS report Reports to include, but not limited to, Denied Claims, Unclaimed, and Claim Detail Export. Problem-solve denied claim errors, replace claims, and collaborate with DMH Revenue Management on unresolved issues, when needed. Provide corrective action for monthly Void Report. Disperse Unclaimed Report to data entry staff monthly.
• Run weekly/monthly, or as needed identified client status IS reports, i. 30/60/90 Day Report, UMDAP, and disperse to designated Quality Assurance staff for follow-up.
• Run EFT, raw data claims reports as ne
• Manage quarterly OPS program progress note/billing review Review and assess OPS clinician feedback and cross-reference against original service log. Make appropriate corrections in the DMH IS. Maintain record of changes made.
• Manage the electronic submission of all DMH contract eligible staff’s Rendering Provider and PRM online information to add new staff, update license/registration and valid taxonomy information, add NPI and provider number to staff members, and submit staff termination documentation to DMH. Maintain active staff provider binders with staff personnel sheets and current license, NPI and taxonomy. Run IS280 report monthly to obtain list of rendering provider information and insure TIER is updated with NPI and rendering provider numb Follow-up with Human Resource regarding expired or missing licenses.
• Manages the Outcomes submission for Evidenced Based Practice and Field Capable Clinical Services cases into the DMH OMA web site. Is responsible for training other assigned staff in the protocol to ensure submission is accurate and timely.
• Attends DMH meetings and trainings that pertain to her job responsibilities, i. data reporting, outcomes reporting, etc., and informs staff of updates and changes, and trains staff as needed.
• Supervises billing staff, ensuring that billing standards, practices and protocols are consistently me meets regularly with supervisees to review assignments and any billing issues that may arise. Provides direction to assist with problem solving and when corrective action is needed.

Benefits

• Full benefits offered (Medical, Dental, Vision)
• FSA/Dependent Care and Supplemental benefits through The Standard
• 403(b) – 3% Employer contribution based off annual salary
• 4 Mental Health Days
• Up to 12 Paid Holidays
• Up to 25% for Cell Phone Discounts with 3 Major Carriers (AT&T, Verizon, Sprint)

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees