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Medical Billing Audit Team Lead

Company: Premier Medical Resources
Location: Houston
Posted on: May 16, 2022

Job Description:

Job DescriptionPremier Medical Resources is in search of a team member to join our Revenue Cycle Management as a Medical Billing Audit Team Lead. This position is responsible for performing quality reviews to validate the integrity of medical reviews and other documentation under and over coded services, prepares report of findings and meets with management to educate on and improving coding practices.About Premier Medical ResourcesPremier Medical Resources, LLC is a healthcare management company, headquartered in NW Houston near the Jersey Village area. PMR provides services to a network of healthcare clinics and hospitals around Texas. These services include staffing, logistics, operations, human resources, billing, accounts receivable, legal, IT, scheduling, and more.ESSENTIAL FUNCTIONS

  • Performs a comprehensive medical records review to assure the presence of all component parts including patient and record identification signatures, dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
  • Ensures all documentation is accurate and compliant with federal laws in terms of composition
  • Reviews payment denials, underpayments, and payment take backs for appropriateness and guides resolution by resubmission to the insurance carrier, patient billing, or appropriate adjustment
  • Collaborates with the Medical Records Manager and the Medical Coding/Billing Manager to identify opportunities for improvement and efficiency
  • Advises management to develop more effective policies and procedures and communicate with third-party payers, which includes insurance companies and government payers regarding medical coding or billing issues
  • Fulfills internal and external requests for outcome data, including developing special reports
  • Monitors and reinforce the organization's policies, procedures, and ethical conduct
  • Provides oversight and training to the staff in the Audit DepartmentKNOWLEDGE, SKILLS, AND ABILITIES
    • Knowledge with in and out of network insurances, Workers Compensation, insurance verification, patient responsibility, and process for prior authorization
    • Knowledge of interpreting EOBs, posting payments, and adjusting accounts appropriately
    • Familiarity with ICD-10 and CPT codes and procedures
    • Proficient in medical coding guidelines and regulations
    • Working knowledge of medical jargon and anatomy
    • Must be task-oriented and have organizational skills
    • Strong attention to detail
    • Ability to communicate professionally with outside parties
    • Ability to adapt with flexibilityMINIMUM QUALIFICATIONS
      • 2 years of medical office or facility setting experience (required)
      • 2 years of medical billing auditing experience (required)
      • 2 years of insurance billing and coding experience (required)
      • 2 years of orthopedic or surgery experience as a biller (preferred)BENEFITS:We are offering a comprehensive benefits package including:
        • 401(k) with employer contribution
        • Medical Insurance
        • Dental Insurance
        • Vision Insurance
        • Short and Long Term Disability Insurance
        • Employee Assistance Program
        • PTO + Holidays

          Job Posted by ApplicantPro

Keywords: Premier Medical Resources, Houston , Medical Billing Audit Team Lead, Healthcare , Houston, Texas

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