Enrollment & Billing Director jobs in Providence, RI

Job Title: Billing Director :

We are THE WECARE GROUP, and our mission is to help our patients and each other “See Life’s Special Moments, More Clearly”. We are aligned in our pursuit to see every team member reach their personal, professional, and financial goals through the work we do together. Our core values are the backbone of our business and guide our hiring process: we are Accountable, Aligned, Ethical, Excellent, Community Focused, and Results Driven

Job Description:

We are seeking a highly skilled and experienced Billing Director to join our reputable optometry practice. The Billing Director will be responsible for overseeing and managing all aspects of the billing, credentialing, and revenue cycle operations, including payer contracts. Familiarity with billing codes for medical and vision claims is essential for this role.

Key Responsibilities:

· Develop and implement billing policies and procedures to ensure accurate and timely billing processes for both medical and vision claims.

· Manage the billing team and provide leadership and guidance to ensure efficient operations.

· Oversee the credentialing process for payer contracts to optimize reimbursement rates.

· Ensure proper coding and submission of claims for both vision and medical services.

· Monitor billing performance metrics and analyze data to identify areas for improvement.

· Collaborate with providers, staff, and payers to resolve billing issues and discrepancies.

· Stay updated on industry regulations and compliance requirements related to billing practices.

· Charge review & posting of paper fee tickets as applicable.

· Resolve claim edits daily while noting account actions for a complete audit trail of billing activity.

· Ensure all prior day's edits have been accurately resolved and the claim is ready to bill.

· Submission of assigned claims to third-party payers.

· Process clearinghouse rejections daily for assigned payers.

· Maintain applicable system and website logins and review payer correspondence or bulletins for protocol or regulatory changes.

· Maintain a complete understanding of bill edit and submission protocols within required software systems.

· Identify opportunities for new claim edits and provide recommendations to management for the implementation of identified edits.

· Identify root cause issues causing claim edits and communicate these issues to RCM leadership for upstream education via an understanding of how billing edits impact overall AR.

Qualifications:

· Bachelor’s degree in business administration, Healthcare Management, or related field.

· Previous experience in billing, credentialing, and revenue cycle management in a healthcare setting, preferably in an optometry practice.

· Strong knowledge of medical billing software and coding systems.

· Familiarity with billing codes for medical and vision claims.

· Experience in credentialing with various payers to secure favorable contract terms.

· Excellent communication and leadership skills.

· Detail-oriented with a focus on accuracy and efficiency.

· Benefit: Certification as a biller coder is preferred but not required.

We offer a competitive salary, benefits package, and the opportunity to work in a collaborative and dynamic healthcare environment. If you are a skilled Billing Director with expertise in optimizing revenue cycle operations, billing for optical and medical claims, credentialing payer contracts, and are a certified coder, we invite you to apply for this rewarding opportunity.

We look forward to welcoming a dedicated Billing Director to our team and driving continued success in our practice.

Location; Remote ( travel as needed to New Providence Rhode Island )

Email : Mlovizio@wecareeyegroup.com

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: Hybrid remote in Providence, RI 02903