Medical Billing and Collections Specialist (Glendale, CA - On Site) - PrimeMSOSurgicalCenters

Job Description

The Case Manager primarily handles billing processing and collections on medical claims for multispecialty Ambulatory Surgery Centers. This role will manage patient billing processes, ensure accurate and timely submission of claims, and facilitate the resolution of billing issues. This role requires strong organizational skills, exceptional attention to detail, and the ability to communicate effectively with patients, insurance companies, and healthcare providers. The Billing Case Manager will also be responsible for maintaining accurate records, preparing financial reports, submitting appeals, records and managing the complete revenue cycle of accounts. This position will require Case Managers to manage revenue cycle best practices as they relate to the organization’s revenue cycle management processes and staying up to date with industry regulations and coding standards.

Functions:

• Ensure accurate and timely submission of insurance claims, adhering to regulatory requirements and organizational policies.
• Monitor the processing of payment receipts, ensuring they are completed efficiently and correctly.
• Maintain thorough documentation of all billing activities for compliance and audit purposes.
• Oversee the entire revenue cycle process; from patient registration/inquiry, insurance verification validation, claims submission, payment negotiations, follow-up, appeal submission, payment posting, and case adjustments.
• Train and support staff in revenue cycle activities to ensure consistency and effectiveness across the organization.
• Communicate effectively with patients regarding billing inquiries and payment plans.
• Perform regular account reviews to identify and address potential issues that could lead to bad debt.
• Implement and monitor strategies to reduce bad debt and improve overall collection rates.
• Perform regular account reviews to ensure account receivable aging is within the organization standards.
• Develop and implement practices to enhance cash flow, ensuring timely collection of payments.
• Monitor financial metrics and key performance indicators (KPIs) related to cash flow and make necessary adjustments to strategies.
• Oversee collections activities, ensuring timely follow-up on outstanding accounts and coordination with collection agencies as needed.
• Ensure compliance with all federal, state, and local regulations related to medical billing and collections.
• Prepare and submit regular reports on billing and collections activities to the Business Operations Manager/Director of Revenue Cycle Management and other senior management.
• Stay updated on changes in billing regulations and guidelines and implement necessary adjustments to processes.
• Perform additional tasks and responsibilities as assigned by the management team.
• Participate in continuous improvement initiatives to enhance the efficiency and effectiveness of the billing department.
• Provide guidance and support to billing team members, fostering a collaborative and productive work environment.
• Share best practices and industry knowledge with team members to enhance overall team performance.
• Perform and assist any special projects or assignments as directed by management. 

Skills and Qualifications:

• Knowledge and understanding of PPO/Federal/HMO/POS Health Plan Benefits.
• Strong knowledge of medical billing codes, regulations, and insurance processes.
• Knowledge of billing guidelines for contracted and non-participated Ambulatory Surgery Centers.
• Knowledge of multiple medical billing functions in the revenue cycle management lifecycle.
• Insurance correspondence resolution and appeals overview and submission.
• Ability to identify problems and demonstrate reliability & ability to communicate constructively, Strong verbal and written communication skills
• Knowledge and understanding of facility billing for in-network, federal, out-of-network and non-participated providers.
• Ability to work independently and as part of a team.
• Ability to identify issues and barriers, find solutions, and evaluate the success of their ideas.
• Detail-oriented with a commitment to accuracy and compliance. 
• Microsoft Office Suite - highly proficient.
• Bachelor’s degree in healthcare administration, business, or a related field. (Preferred)

Requirements:

• Minimum of 3-5 years of experience in medical billing and collections, with a focus on revenue cycle management.
• Federal/In-network/Out-of-Network payor knowledge - all payors
• Dept of Justice Background Check 
• Satisfactory Completion of Health/Drug Screening 
• Proof legal US work eligibility 
• Valid CA Class C Drivers License 

Company Description

Since 2014, Prime MSO has developed and managed surgical facilities that provide patients with the highest level of surgical care. Today we are one of the reliable and independent operators of outpatient surgery centers in the Los Angeles area, covering virtually the full range of surgical specialties.

Our remarkable community of teammates, physician partners and health system partners are deeply committed to providing quality patient care and improving healthcare in America. Our focus on building strategic relationships with our partners enables us to acquire, develop and optimize facilities in an aligned economic model that enables better access to high-quality care at a lower cost.

While healthcare is in a constant state of change, we want to make sure it is always for the better. We believe that happier, more fulfilled employees and staff in a fun and dynamic work environment will ultimately provide the best care in the country. At Prime MSO, that means success. Talk to any of our employees about their experiences and hear the difference Prime MSO is making in their lives today.

Benefits

• Health insurance
• 401(k) match
• Dental insurance
• Disability insurance
• Life insurance
• Paid time off
• Vision insurance
• Paid holidays
• Bereavement leave

Part Time

• Paid time off

Workplace Benefits:

Prime believes in fostering a rewarding and caring workplace environment. We understand the importance of work-life balance and appreciate the time our employees invest in us. To show our appreciation, we strive to create a fun environment. We celebrate all staff birthdays and major life events. We have at least two company-wide events each year including Derby Days where all Prime staff are invited to attend a fully paid for trip to racing tracks on a race day and a Holiday party usually at an upscale restaurant in downtown LA. We celebrate holidays at individual locations throughout the year including potlucks for Thanksgiving and Secret Santa or White Elephant events during winter. Working at Prime is like working with your closest friends and family.

We also strive to give back to our community. We proudly host food drives, toys for tots, and raise money for local charities in our area. When creating and conducting these charitable events, we always choose local charities where we can see where the charitable efforts in action.

To promote good work-life balance, we have adopted a competitive PTO policy where all first-year full time employees accrue 14 total days of PTO (almost three weeks of paid time off). The number of PTO days able to accrue increases with each year of employment too. We offer 48 hours of paid sick time to all full-time employees with part-time and even per diem employees able to accrue paid sick time based on hours worked. We also offer paid bereavement leave in the event of a close family member passing away.

Vision and Dental insurance are fully paid for by the company. We offer generous contributions to all medical health plans with increased contribution to managers. Our medical plans offered include HMO and PPO options with infertility coverage. As a Prime employee, you also have unique access to our surgical facilities and doctors for health needs as Prime strongly believes in the importance of access to good and affordable medical care.

Prime strongly values continued education and training for our employees. We assist our nursing staff in obtaining certifications when necessary and offer a tuition reimbursement program. We offer cross-training at our facilities so our employees can broaden their knowledge, skill, and experience. We believe in the importance of meeting your full potential and do all we can as a company to help you achieve it.

Profit Share

Eligible employees participate in the organization's profit share within the billing and collections department on a quarterly basis. Eligibility and restrictions may apply.