Claims Processing Manager
M
MercorMedical Billing
United StatesContractManager
Salary80 USD per hour
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Job Details
- Languages
- English
- Experience
- 5+ years
- Required Skills
- HIPAA
Requirements
- 5+ years of experience in medical billing and claims management.
- At least 2 years in a management role.
- Deep knowledge of professional fee (CMS-1500/837P) and/or facility (UB-04/837I) billing requirements.
- Expertise in HIPAA 837 transaction standards, clearinghouse operations, and payer-specific billing rules.
- Strong understanding of Medicare, Medicaid, and commercial payer billing requirements.
- Proficiency with billing platforms (Epic, Athenahealth, AdvancedMD, or equivalent) and clearinghouse tools.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to identify billing errors and compliance issues in AI-generated outputs.
- CPC, CCS, CHFP, or CRCR certification preferred.
- Experience with automated billing platforms and RCM technology implementations preferred.
Responsibilities
- Oversee end-to-end medical billing and claims submission operations across professional fee and/or facility billing environments.
- Evaluate AI-generated billing outputs, claim edits, and coding validations for accuracy and payer compliance.
- Manage claims submission workflows including electronic claim generation, clearinghouse edits, and payer-specific billing requirements.
- Monitor clean claim rates, rejection rates, and first-pass acceptance rates.
- Coordinate with coding, CDI, and collections teams to resolve billing edits and claim rejections.
- Ensure compliance with CMS billing guidelines, HIPAA 837 transaction standards, and payer-specific billing rules.
- Annotate AI outputs and provide structured feedback to support AI training datasets.
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