Medical Billing & Claims Manager
A contract opportunity to apply deep revenue cycle expertise in evaluating and improving automation tools designed to enhance claim accuracy and first-pass acceptance across professional fee and facility billing environments. This role sits at the intersection of billing operations and next-generation healthcare technology development.
$80/hr | Flexible Schedule | Remote
Key Responsibilities
• Oversee end-to-end claims submission workflows across professional fee (CMS-1500/837P) and facility (UB-04/837I) billing environments, ensuring payer-specific compliance at each stage.
• Evaluate automation-generated billing outputs, claim edits, and coding validations against CMS guidelines, HIPAA 837 transaction standards, and payer billing rules.
• Monitor clean claim rates, rejection rates, and first-pass acceptance metrics; develop and implement targeted improvement strategies.
• Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections, maintaining operational throughput and quality benchmarks.
• Develop and maintain billing SOPs and payer-specific reference guides to standardize workflows and support training dataset annotation.
• Provide structured, expert feedback on model-generated billing outputs to directly inform the development of revenue cycle automation systems.
Core Requirements
• Demonstrated expertise in medical billing and claims management, including direct management responsibility for billing staff productivity and quality performance.
• Deep command of professional fee and facility billing requirements, HIPAA 837 transaction standards, and clearinghouse operations.
• Comprehensive knowledge of Medicare, Medicaid, and commercial payer billing rules, including payer-specific edits and adjudication logic.
• Proficiency with enterprise billing platforms (Epic, Athenahealth, AdvancedMD, or equivalent) and clearinghouse tools.
• Proven ability to identify billing errors, coding inaccuracies, and compliance gaps within complex or high-volume claim outputs.
• Exceptional written English communication skills with precision sufficient for structured annotation and compliance documentation.
Additional Strengths
• Active credentialing such as CPC, CCS, CHFP, or CRCR is a strong differentiator.
• Background in multi-specialty physician group, hospital, or health system billing operations; experience with RCM technology implementations is advantageous.
• Familiarity with payer contract interpretation and billing compliance program oversight.
Applications will be reviewed only via LinkedIn Easy Apply.