Medical Billing and Claims Management

This subcontract for Medical Billing and Claims Management supports prime contractors on Office of Health Facilities projects in Charleston, West Virginia. The selected provider will manage professional, inpatient, and outpatient billing processes, utilizing revenue cycle management systems and clearinghouses to ensure strict adherence to coverage guidelines and fee schedules. The primary objective is to maintain a high standard of operational excellence, specifically targeting a clean claim rate between 94% and 97% and an overall accuracy rate of 98%. The contractor is required to possess deep expertise in applying modifiers and must operate in full compliance with HIPAA regulations and OIG guidelines. Key deliverables include the submission of clean claims and the provision of detailed billing reports. This opportunity falls under NAICS code 541219 and is managed by the state of West Virginia.