Medical Billing & Coding Team Lead (Remote)

Essential Duties and Responsibilities:
- Monitor the performance of, manage workloads of and perform case assignment for a team of Coordinators and assist with training and staff hiring.
- Develop and maintain processes and procedures at the direction of the director, liaison with Project Directors regarding procedural issues, and communicate with the CA Division of Workers' Compensation (DWC) regarding policy and eligibility issues.
- Manage complex case files from the date received to date closed for Independent Billing Review (IBR) and determine eligibility of CA IBR appeals.
- Respond to requests from Billing for additional information from Claims Administrators as needed.
- Manage complex case files from date received to date closed.
- Determine eligibility of appeals and submit potentially ineligible cases to the CA DWC for final eligibility determination.
- Request additional information from Claims Administrators.
- Draft correspondence regarding eligibility and assignment.
- Manage the workload of all Coordinators to ensure timeliness of IBR reviews.
- Collaborate with the client to address policy issues that arise in the content of review.
- Ensure that process is being completed timely according to contract regulations.
- Work with Systems Development staff regarding Entellitrak updates to enhance IBR process.
- Perform other duties as assigned by management.

Minimum Requirements

- High School diploma or equivalent or Associate degree with 1.5 - 4 years of experience.

- Additional clinical licensure may be required based on project.
- Additional training or education in area of specialization.
- Works on a variety of assignments requiring considerable judgement and initiative.
- As a skilled and experienced specialist, completes tasks in resourceful and effective ways.
- Able to draft or modify training materials and procedural documentation accurately.
- Skilled in handling challenging communications with external contacts for escalated matters.
- Act independently to determine methods and procedures on new assignments.
- Serves as facilitator and team leader, allocating work and providing guidance and training to others in field of specialization.
- Perform quality assurance on work of others in team.

Preferred Requirements

- Experience with reading and reviewing Explanation of Reviews

- Explanation of Benefits, Remittance Advice, or similar payor issued documents.
- Experience in billing and or coding medical claims.

- Experience with Health Plans, as a claims examiner processing medical claims.
- Familiarity with Medical Claim Forms and CPT, HCPCS, ICD-10-CM codes.
- Experience with Medical Claim Appeal Processes, appealing and receiving/reviewing appeals.

Home Office Requirements

- Maximus provides company-issued computer equipment

- Reliable high-speed internet service



* Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity



* Minimum 5 Mpbs upload speeds

EEO Statement

Maximus is an equal opport...