Essential Duties and Responsibilities include the following.
Other duties may be assigned.
Revenue Cycle Management – End to End
- Handle full-cycle billing: Authorization/Utilization Review, eligibility checks, charge entry, claims submission, payment posting, AR follow-up, denial management, and patient collections.
- Utilize Tebra for all billing, claims, reports, corrections, and workflow management.
- Ensure timely and accurate claims submission to commercial payers, Medicare, and Medicaid.
- Review clinical documentation for wound care coding accuracy,
- Apply correct CPT/ICD-10 codes, modifiers, wound measurements, and medical necessity criteria.
Claims Management & AR
- Track and capture all visits/services to ensure complete and accurate billing.
- Review, submit, and process all medical bills and claims to insurance companies and government programs.
- Verify accuracy of demographic, insurance, and billing information prior to claim submission.
- Proactively follow up for timely payment and resolve unpaid claims, denials, discrepancies, and rejections.
- Generate and analyze aging reports, AR summaries, and denial trends.
- Monitor timely filing limits and ensure adherence to payer guidelines.
Financial Coordination & Reconciliation
- Reconcile patient accounts and generate accurate patient statements.
- Process patient responsibilities, statements, payment plans, and outstanding balances.
- Maintain organized billing and financial records.
- Balance financial records daily, weekly, and monthly.
- Generate month-end reports, reconcile accounts, and submit financial summaries to leadership.
Provider & Insurance Coordination
- Communicate with providers regarding missing documentation, wound measurements, and coding clarifications.
- Coordinate with insurers, clearinghouses, and payers for claim resolution or benefit clarification.
- Assist with obtaining insurance pre-authorizations and pre-certifications as needed.
Support continuous improvement of billing workflows and documentation accuracy.
Compliance & Reporting
- Maintain HIPAA compliance and adhere to payer guidelines.
- Generate RCM performance reports, including AR aging, denial trends, and reimbursement analysis.
- Identify process gaps and recommend best practices to enhance RCM efficiency
Key Qualifications:
- 5-10 + years of experience in Revenue Cycle Management
- Experience with wound care billing is a “nice to have”
- College degree or equivalent; Healthcare Administration or related field preferred.
- Advanced proficiency in Tebra for billing and RCM functions (required).
- Strong understanding of:
- CPT/ICD-10 codes related to wound care
- Medical necessity rules and documentation requirements
- Facility vs. office wound care billing differences
- AR/Claims management and denial resolution
- Handling high-volume wound care encounters
- Strong analytical, communication, and organizational skills.
- High level of accuracy, attention to detail, and ability to work independently.
- Experience with US payer processes (commercial, Medicare, Medicaid).
Shift / Hours:
Monday – Friday from 8:00 AM PST – 5:00 PM PST in one single shift.. Note this is +13 or +14 Philippine Jeffe, which will be 8:00 PM PHT – 5:00 AM in PHT.
Business Overview:
The practice has 3 locations in Northern California specializing in wound care.
Location: Sacramento, CA