Description
Maximus is seeking a Medical Billing & Coding Team Lead to support the Independent Bill Review (IBR) Program. This role is ideal for someone who excels in a fastpaced environment, demonstrates strong judgment, and ensures accuracy and compliance in a highly regulated workflow. As the Medical Billing & Coding Team Lead, you will coordinate daily case activity, guide team members through complex processes, and serve as a key point of contact for procedural, policy, and eligibilityrelated questions.
You will play a critical role in supporting program operations by managing case assignments, maintaining process integrity, collaborating with project leadership, and ensuring all IBR reviews meet contractual and regulatory timelines. This fully remote position offers the opportunity to influence operational efficiency and contribute to a highvisibility, highimpact project.
This full-time position is fully remote.
What You’ll Do:
Oversee daily IBR case assignments and ensure timely completion.
Provide guidance on eligibility, documentation, and processes.
Manage complex cases from intake through appeal review and draft determinations.
Partner with leadership and DWC on policy matters.
Ensure compliance with timelines and support workflow improvements and training.
Why Maximus?
- Work/Life Balance Support - Flexibility tailored to your needs
- Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance
- Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching
- Paid Time Off Package – Enjoy PTO, Holidays, and extended sick leave, along with Short- and Long-Term Disability coverage
- Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP)
- Recognition Platform - Acknowledge and appreciate outstanding employee contributions
- Tuition Reimbursement - Invest in your ongoing education and development
- Employee Perks and Discounts - Additional benefits and discounts exclusively for employees
- Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs
- Professional Development Opportunities-Participate in training programs, workshops, and conferences
- Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees
Essential Duties and Responsibilities:
- Monitor the performance of, manage workloads of and perform case assignment for a team of Coordinators and assist with training and staff hiring
- Develop and maintain processes and procedures at the direction of the director, liaison with Project Directors regarding procedural issues, and communicate with the CA Division of Workers' Compensation (DWC) regarding policy and eligibility issues
- Manage complex case files from the date received to date closed for Independent Billing Review (IBR) and determine eligibility of CA IBR appeals
- Respond to requests from Billing for additional information from Claims Administrators as needed
- Manage complex case files from date received to date closed
- Determine eligibility of appeals and submit potentially ineligible cases to the CA DWC for final eligibility determination
- Request additional information from Claims Administrators
- Draft correspondence regarding eligibility and assignment
- Manage the workload of all Coordinators to ensure timeliness of IBR reviews
- Collaborate with the client to address policy issues that arise in the content of review
- Ensure that process is being completed timely according to contract regulations
- Work with Systems Development staff regarding Entellitrak updates to enhance IBR process
- Perform other duties as assigned by management
Minimum Requirements:
- High School diploma or equivalent or Associate degree with 1.5 - 4 years of experience
- Additional clinical licensure may be required based on project
- Additional training or education in area of specialization
- Works on a variety of assignments requiring considerable judgement and initiative
- As a skilled and experienced specialist, completes tasks in resourceful and effective ways
- Able to draft or modify training materials and procedural documentation accurately
- Skilled in handling challenging communications with external contacts for escalated matters
- Act independently to determine methods and procedures on new assignments
- Serves as facilitator and team leader, allocating work and providing guidance and training to others in field of specialization
- Perform quality assurance on work of others in team
Preferred Requirements:
- Experience with reading and reviewing Explanation of Reviews
- Explanation of Benefits, Remittance Advice, or similar payor issued documents
- Experience in billing and or coding medical claims
- Experience with Health Plans, as a claims examiner processing medical claims
- Familiarity with Medical Claim Forms and CPT, HCPCS, ICD-10-CM codes
- Experience with Medical Claim Appeal Processes, appealing and receiving/reviewing appeals
Home Office Requirements:
- Maximus provides company-issued computer equipment
- Reliable high-speed internet service
- Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity
- Minimum 5 Mpbs upload speeds
