Operations and Escalations Manager - Codemax Medical Billing

Operations and Escalations Manager

Location: Van Nuys, CA (On-Site)

Employment Type: Full-Time, Exempt

Company Overview:

Join a dynamic team where your leadership and problem-solving skills will make a significant impact. We are a leading provider in the healthcare industry, committed to ensuring accurate and efficient medical billing operations. We are looking for a highly motivated Operations and Escalations Manager to lead a team and oversee medical billing processes, ensure compliance, and provide exceptional customer service.

Position Summary:

The Operations and Escalations Manager is responsible for managing a team focused on billing operations, handling insurance claims, and maintaining compliance with medical records standards. This position requires expertise in medical billing, coding, and insurance claims, combined with strong leadership and customer service skills. You will work proactively with clients and internal departments to resolve billing issues, ensure compliance, and drive operational efficiency.

Key Responsibilities:

• Lead, mentor, and manage a team to achieve departmental goals.

• Handle hiring, performance management, and partner with HR to address performance issues.

• Manage and organize Substance Abuse (SA) and Mental Health (MH) medical records to ensure compliance.

• Utilize knowledge of ASAM, LOCUS, and MCG criteria to assess and recommend appropriate treatments.

• Ensure confidentiality of patient information in compliance with HIPAA regulations.

• Proactively communicate with clients, anticipate customer impacts, and resolve billing issues.

• Oversee unpaid claims, manage denials, and assist with appeals.

• Provide regular reporting on operational metrics and client interactions.

• Serve as a key escalation point for complex billing and operational issues.

• Train staff and peers on medical billing procedures and industry best practices.

Qualifications:

• Bachelor’s or Master’s degree in a clinical field (psychology, social work, or related field).

• Certification or specialized training in ASAM, LOCUS, MCG (preferred).

• Minimum 3 years of clinical experience with a focus on Substance Abuse and Mental Health.

• Proven leadership experience, including hiring, managing, and developing teams.

• Strong knowledge of electronic health records (EHR) and clinical assessment tools.

• Exceptional problem-solving, analytical, and communication skills.

• Ability to resolve customer/patient issues and de-escalate challenging situations.

Physical Requirements:

• Ability to sit for extended periods and perform computer-based tasks.

• Light lifting (up to 15 lbs.) may be required.