What are the responsibilities and job description for the ER-Based Microhospital Billing Consultant position at Calpion/Plutus Health?
About Plutus Health Inc.
Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services with SOC2 Certification. We specialize in helping healthcare providers enhance financial performance across various specialties. Recognized on the Inc. 5000 list and ranked #100 in the Dallas area, we were also a 2024 finalist for the EY Entrepreneur Of The Year award.
Job Summary:
We are seeking an experienced Billing Consultant with specialized expertise in ER-based microhospital billing. The ideal candidate will have deep knowledge of billing processes, coding, and compliance regulations specific to microhospitals, particularly within emergency department services. This role will involve assessing, optimizing, and ensuring accurate and efficient billing workflows to maximize revenue and compliance.
Key Responsibilities:
- Provide expert guidance on ER-based microhospital billing processes and best practices.
- Analyze and optimize billing workflows, coding accuracy, and reimbursement strategies.
- Ensure compliance with CMS, Medicare, Medicaid, and commercial payer regulations.
- Identify billing gaps, denials, and revenue leakage, and recommend corrective actions.
- Collaborate with internal teams, including RCM specialists, coders, and finance teams, to streamline processes.
- Conduct training sessions and provide insights on industry updates and regulatory changes.
- Develop and implement strategies for improving claim accuracy and reducing denials.
Required Qualifications:
- Proven experience in ER-based microhospital billing and RCM processes.
- In-depth understanding of ICD-10, CPT, HCPCS coding, and payer guidelines.
- Strong knowledge of medical necessity documentation and billing compliance.
- Hands-on experience with billing software and electronic health record (EHR) systems.
- Ability to analyze data, identify trends, and drive revenue cycle improvements.
- Excellent communication and collaboration skills.
- [Optional] Certifications such as CPC, CCS, or CRCR are a plus.
Why Join Plutus Health Inc.?
- Opportunity to work with a leading healthcare RCM company.
- Engage in impactful projects that drive financial success for healthcare providers.
- A collaborative and growth-focused work environment.
