Duties and Responsibilities
- Clean, review, and submit claims for behavioral health providers (specifically autism providers)
- Track claim statuses and remittances
- Work denials and follow up with unpaid claims proactively
- Manage patient responsibility invoices (e.g., patient co-insurance, co-pays)
- Evaluate insurance operations and identify efficiency improvements
- Analyze EOBs and post manual payments
- Submit and follow up on Commercial and Medicaid, primary and secondary insurances
- Communicate to administrative team for errors and corrections
- Work and manage claims from all aging buckets including posting and appeals, including resubmission of claims and appropriate adjustments.
- Input and review billing data for accuracy, including data entry.
- Ensure that billing and collections adhere to all compliance policies and procedures.
- Work with Billing Manager and local clinic team members to ensure accurate billing.
- Follows up on claim resolution from initial billing through final resolution including identifying and correcting billing errors/rejections and denials (denial management investigations & appeals).
- Manage claims submission and AR for assigned clinics.
- Process remittance advices/EOB’s to achieve finalized clean claims for payment including researching and correcting denials (Pull EFT back-ups).
- Post and reconcile payments received using system and deposit reports.
- Maintain confidentiality of all patient information.
- Perform other duties as assigned
Qualifications
- BS or BA degree in Finance, Accounting, healthcare administration or related field, preferred, and/or equivalent work experience in revenue cycle management or medical billing function
- 1 to 3+ years of experience in healthcare within revenue cycle management or medical billing function
- 1 to 3+ years of experience working with Medicaid and MCO’s within medical billing process
- Experience in a high growth and fast paced environments
Knowledge, Skills and Abilities
- Advanced level skills in the use of the Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook eMail and Calendar
- Strong mathematical and analytical skills
- Detail oriented and deadline driven
- Ability to read and analyze ERA remittances for appropriate posting and/or denial resolution actions
- Ability to apply current knowledge to more complex tasks in order to achieve elevated results, leading to continuous improvement
- Proven ability to work and collaborate with other team members and to maintain a positive attitude
- High level of integrity and dependability and the ability to manage multiple projects and competing priorities
- Ability to successfully complete required background and drug screens
Working conditions
Physical Conditions:
- Ability to bend, kneel, crouch, and spend time standing as well as an ability to lift items up to 25 lbs.
- Endurance to move from a seated position to a standing position to accomplish required tasks
- Requires eye-hand coordination and manual dexterity enough to operate office equipment, etc.
- Ability to effectively communicate both orally and audibly using a variety of software communication platforms and electronic devices