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Medical Billing Manager

Medical Billing Manager

Gateway RecruitingSan Francisco, CA, US
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Job Description

Job Description

The Opportunity :

The Manager of Medical Billing & Coding will lead the strategy, operations, and compliance of the Company's medical billing and coding functions. This role ensures accurate, timely, and compliant billing practices, with a focus on optimizing revenue cycle performance, enhancing payer-provider alignment, and supporting patient satisfaction. The ideal candidate brings deep expertise in healthcare billing, coding standards (ICD-10, CPT, HCPCS), and payer regulations, along with strong leadership and cross-functional collaboration skills.

Job Responsibilities :

Act as a resource

  • Demonstrate the ability to request, review, and code medical services from reports and notes in order to convert procedural and diagnostic notes into appropriate levels of care following coding rules and regulations.
  • Ability to understand CMS NCD, LCD guidelines to support coding decision making
  • Identify clinical documentation deficiencies and recommend methods for resolution that satisfy regulatory and compliance requirements.
  • Perform medical chart audits, meeting minimum department productivity standards.
  • Exercise mature judgment and maintain confidentiality in all activities

Coding and compliance

  • Assure compliance with ICD-10-CM / PCS and CPT-4 rules and guidelines as well as facility-specific requirements.
  • Implement CMS and the Correct Coding Initiative Guidelines (CCI)
  • Identify areas of potential coding, billing, and documentation deficiencies.
  • Provide suggestions to resolve areas of deficiency to management.
  • Identify areas of potential Compliance risk and notify management immediately.
  • Ensure the accuracy of all work and strive to achieve 100% accuracy.
  • Identify anomalies in coding and fix them immediately.
  • Identify ways to avoid errors and issues and create safeguards to prevent them from happening again.
  • Support commercial and IT teams with coding guidance and handholding Change management processes
  • Data collection and reporting

  • Demonstration of strong knowledge of coding software and databases used by the Company.
  • Continually strives to increase knowledge of electronic data systems and reporting tools to enhance value.
  • Designing and developing special reports within a specified timeframe.
  • Participation in job-related conferences, seminars, and workshops.
  • Review of various coding publications for changes and relay information to pertinent parties.
  • Maintains average Billing lag days of 7 days or less.
  • Data entry

  • Verify that each charge contains the necessary charge elements on EMR and Salesforce.
  • Special Projects - participates in projects that improve department production and / or efficiency.
  • Identify and trends errors.
  • Ensure all charges are entered into correctly and accounted for.
  • Be able to perform charge entry and all other charge-related procedures.
  • General support

    Perform other duties as assigned.

    Process improvement

    Independently researches coding questions, documents findings, makes recommendations and provides documentation that supports the recommended solutions.

    Provides professional and courteous support to Revenue cycle and commercial teams through email, phone and in-person contact, answering questions and providing supporting documentation.

    Provides timely and accurate answers to inquiries presented by customers on clinical coding issues.

    Maintain a positive attitude and productive relationship with peers, physicians, coworkers and management.

    Provides updates and status reports to management.

    Participates in coding / auditing discussions to ensure that the best practice efforts and processes are followed to allow for maximum reimbursement through appropriate coding.

    Required Qualifications :

    Minimum of 7 years in Revenue Cycle Management

    Experienced in change entry and coding

    Active coding certification

    Preferred Qualifications :

    Bachelor's degree in healthcare administration, Business, or related field

    Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification required.

    7+ years of progressive experience in medical billing and coding

    Strong knowledge of healthcare reimbursement, payer policies, and regulatory compliance.

    Experience with electronic health records (EHR), billing software, and revenue cycle management tools.

    Excellent communication, analytical, and problem-solving skills.

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    Medical Billing Manager • San Francisco, CA, US