Medical Insurance Consultant (Coding & Billing)

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We are seeking a strategic-minded and experienced Medical Insurance Billing and Coding Consultant to provide high-level guidance and oversight of our insurance operations. The ideal candidate will leverage their deep expertise to optimize workflows, ensure compliance, and maximize revenue through effective billing and coding strategies. This role will focus on developing and implementing robust Standard Operating Procedures (SOPs) and providing expert guidance to the team responsible for executing billing and coding tasks. The consultant will not be directly involved in submitting claims or performing day-to-day billing/coding functions long term but will be instrumental in shaping the processes to ensure efficiency, accuracy, and a positive client experience. Key Responsibilities: Strategic Oversight of Client Onboarding: Design and optimize the client insurance onboarding process, providing guidance to the onboarding team to ensure seamless enrollment and coverage for services. SOP Development and Implementation: Develop, implement, and maintain comprehensive SOPs for medical insurance billing and coding workflows, including authorizations, claims submission, payment follow-up, denial management, and compliance. Coding Guidance and Compliance: Provide expert guidance on medical insurance coding to ensure accuracy, compliance, and resolution of coding and charge-related claim edits. This includes advising on the appropriate assignment of coding systems, modifiers, and revenue codes, and ensuring adherence to regulatory guidance. Process Analysis and Improvement: Analyze existing billing and coding workflows to identify areas for improvement and develop strategies to optimize efficiency and effectiveness. Cross-Functional Collaboration: Collaborate with other departments to ensure SOPs align with overall business operations and contribute to a positive client experience. Payer Relations Strategy: Advise on strategies for working with insurance companies, including setting up protocols to onboard new clients and ensure accurate and timely payment for services. Denial Management Strategy: Develop strategies for effectively managing claim denials, including appeal processes and recovery efforts. Compliance and Education: Ensure HIPAA compliance and provide guidance on implementing new requirements. Monitor coding changes from governmental agencies and payers and advise relevant departments on coding and compliance issues.

Keyword: Business Consulting

Price: $30.0

Business Process Management Business with 10-99 Employees Regulatory Compliance Project Plans Medical Billing & Coding Medical Records Software ICD Coding