Direct Billing Manager

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This role is full remote

About the Opportunity

At Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Right Payer Solutions Team, as the Direct Billing Manager, you will be responsible for overseeing the end-to-end billing process, collaborating closely with internal teams and external parties to ensure the accurate and timely submissions to insurance companies and the successful receipt of payments.

We are seeking a candidate with demonstrated leadership experience and a comprehensive understanding of medical billing, coding, and denial resolution. This role plays a critical part in supporting team members across these functions and ensuring operational efficiency.

Additionally, the Direct Billing Manager will be accountable for accurately tracking, analyzing, and reporting on key performance indicators to drive continuous improvement and maintain performance standards.

What you'll do

• Maintain operational awareness and support process improvement of Machinify's Direct Billing Program.
• Leverage critical thinking and problem-solving skills to overcome challenges in billing and denial recovery.
• Comprehensive understanding of the medical billing process and internal billing systems. This includes electronic submissions and paper claims.
• Work with insurance carrier representatives to enroll for electronic billing.
• Comprehensive understanding of insurance Explanation of Benefits (EOBs) and payments.
• Reviewing claims, reporting denial trends, and keeping detailed records of communications with Insurance companies.
• Coordinating with providers to obtain medical records and documentation needed for claim processing.
• Knowledge of filing and tracking medical insurance appeals.
• Documents all communication with insurance companies and maintains communication follow-up schedule.
• Must have excellent sense of urgency, attention to detail and organization skills.

• Bachelor's Degree preferred or equivalent combination of education and experience in the health insurance, related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.
• Understanding processes and procedures in Medical Billing/Coding and/or Denial Recovery/Resolution field
• At least one year of previous role related management/leadership in Medical Billing/Coding Denial Recovery/Resolution field.
• Communication experience with insurance companies.
• Good oral and written communication skills, including excellent phone communication skills.
• Strong organizational and administrative skills
• Ability to work well in a team environment.
• Ability to multi-task and work independently as required.
• Excellent time management and analytical skills required.
• Always displays professional behavior in dealings with clients, members, peers, trainees, COB management and any other individual with whom this position interacts. This applies equally to personal, written or telephone contact.

What Success Looks Like...

After 3 months

You will have a strong understanding of the role.

You begin building relationships and collaborating with peers and team members.

You develop effective time and priorities management.

You receive initial feedback about your performance and are using it to improve.

You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.

You have established a strong network of internal relationships and are recognized as a key collaborator.

You've been entrusted with greater responsibility indicating the company's confidence in your abilities.

You see opportunities for career progression and personal development.

Pay range: $70,000-$84,000 USD

This is an exempt position. Compensation will be determined based on several factors including, but not limited to, skill set and years of experience.

What's in it for you

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

What values we'll share with you

• Ask why
• Think big
• Be humble
• Optimize for customer impact
• Deliver results

At Machinify, we're reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative and accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we're passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please contact our People Operations team at peopleoperations@rawlingscompany.com. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/

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