Claim Manager Jobs in Raleigh, NC (NOW HIRING)

SUMMARY: Responsible for billing team leadership, subject matter expertise and performing a variety of regular tasks to ensure timely and comprehensive billing and collections for Medical and Dental services rendered by First Choice Community Health Center (FCCHC) providers. Supervises billing specialists to ensure all tasks are completed timely and accurately. The Revenue Cycle Manager is expected to devote 50% of work time to learn leadership and subject matter expert responsibilities.  The Revenue Cycle Manager should proactively seek to further develop billing process competencies; and assist in implementation of process improvements. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Team Leadership

• Supervise and coordinate the workload of the billing staff to ensure all task are completed accurately and in a timely manner.
• Define and communicate current and new billing tasks and definitions of the billing team.
• Recommend and report billing issues of concern related to clinic operations.
• Run, work and manage reports for the purpose of verifying quality and completeness of various data entry and other functions in the billing EMR system.
• Communicate with FCCHC clinic staff about missing and erroneous data (impeding claim submission) and ensure the completion and correction of the same.
• Work collaboratively with other members of the organization to maximize accuracy and completeness of patient claims and the promptness of the billing cycle.
• Troubleshoot other problems in various billing processes and document to resolution problems discovered.
• Maintain and control documentation of billing processes.
• Execute quality controls processes to ensure consistent billing and collection.
• Monitor third-party coverage contracts, ensuring that current contractual terms are understood and adopted correctly.
• Assist accounting with reconciling the EMR's system monthly patient claim deposits to the general ledger accounts.
•  Assist Director of Finance in completion of the annual costs report, financial audit, annual UDS report, and any other required annual government reporting.
• Create and foster an environment that encourages professional growth of the billing team.
• Other duties as assigned.

Billing Subject Matter Expert

• Study and evaluate new and changing billing requirements and recommend solutions.
• Work directly with providers and clinic operations to revise processes and resolve issues, if required.
• Document significant billing changes and methods of management awareness.
• Monitor changing standards and methods in billing to ensure FCCHC methods and processes are current.

Organizing and Performing Other Tasks

•  Manage and coordinate the billing team's work results for quality, accuracy, and timeliness.
• Oversee and review the transmission of patient claims in the EMR system and other electronic and paper claims processing.
• Follow-up on unpaid claims with standard billing cycle time frame.
• Oversee payment processing for accuracy and compliance.
• Provide excellent customer service to patients inquiring about their accounts and process refund requests, if applicable.
• Providing ongoing orientation and training to billing staff.

REQUIRED SKILLS AND ABILITIES

• Proficient in internet use and Microsoft Office, including Outlook, Word, and Excel.'Strong attention to detail and ability to manage high volumes of work efficiently.
• Effective communicator with patients, insurance payors, and internal staff to resolve billing and claims issues.
• Excellent customer service skills for engaging with patients and families regarding medical and dental claims.
• Strong problem-solving skills to address discrepancies, denials, appeals, and collections.
• Ability to prioritize tasks, delegate when appropriate, and manage conflict constructively.
• Team-oriented with the ability to work independently and follow established policies and procedures.
• Demonstrated commitment to equity, inclusion, and respectful collaboration with diverse populations.In-depth knowledge of insurance guidelines (HMO/PPO, Medicare, Medicaid, etc.) and billing practices.
• Familiarity with CPT and ICD-10 coding; working knowledge of EMRs and billing systems.
• Certified coding certificate or equivalent experience required.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Specifically seeking FQHC experience.

EDUCATION and/or EXPERIENCE: High School diploma required.  Associate's Degree in Medical Billing and Coding preferred or a combination of education and experience.  Minimum of five years progressive billing experience required, including supervisory duties.

LANGUAGE SKILLS: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence.

MATHEMATICAL SKILLS: Ability to apply basic concepts of mathematics and computations.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.  Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

COMPETENCY/SKILLS REQUIREMENTS: Competency required in the areas of communication, excellent verbal and written skills. Use of computer skills to include Microsoft Word and Excel.

CERTIFICATES, LICENSES, REGISTRATIONS: None

OTHER SKILLS AND ABILITIES: Familiarity with effective use of computerized accounting/billing systems. Must be able to use other equipment such as a fax, copier and calculator.  Good organizational skills and the ability to perform numerous tasks simultaneously in a fast-paced office environment.  Good analytical skills, sticker for details, sense of personal responsibility for work performance and a professional attitude.  The ability to work without constant supervision and adhere to policies and procedures is a must.

PHYSICAL/MENTAL DEMANDS: The physical/mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disability to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear, sit, and use hands to finger, handle, or feel objects, tools, or controls.  The employee is occasionally required to stand, walk, climb, balance on two feet, stoop, kneel, crouch, or reach with hands and arms.  The employee must occasionally lift and/or move up to 10 pounds.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Mental demands include the ability to learn, adapt to changes, pay close attention to details, exercise discretion and good judgment, develop options and solutions to crisis and problems, gather and analyze facts, courteous and professional behavior, deal with stressful situations and adhere to company policies and procedures.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the work environment is usually moderate.

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