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Medical Billing Accounts Receivable Specialist

IndependenceFirst
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  1. Position:  Medical Billing/Accounts Receivable Specialist

 

  1. Status:  Full-time, Hourly

 

  1. Reports to: Accounts Receivable Billing Supervisor

 

  1. Position Summary: Submit insurance claims, work denials, post insurance payments, file appeals when appropriate and keep up to date on knowledge of current insurance reimbursement rates and issues.  Work in Sandata Software, clearinghouses, and payor portals.

 

  1. Position Expected Hours of Work: Typical hours are full time 40 hours, Monday through Friday, 8:00AM through 4:30PM.

 

  1. Essential Functions of the Position: 
  2. Perform timely follow up on insurance claim denials, exceptions or exclusions including unpaid or improperly paid claims within all contractual filing deadlines. Utilize aging accounts receivable reports to follow up on unpaid claims aged over 30 days by phone, mail, and/or electronic means.
  3. Read and interpret payor explanations of benefits/explanations of payment, correctly identifying denials and improperly paid claims, and work claims accordingly. Provide detailed and accurate follow-up on assigned work
  4. Maintain detailed functioning knowledge of our billing system. Utilize our internal billing software to sort, filter, summarize and identify various account receivable trends.
  5. Work collaboratively with the Accounting Team to ensure all claims are submitted with a goal of zero errors. This includes verifying completeness and accuracy of all claims prior to submission through Clearinghouse and working with Accounting Team to accurately post all insurance payments by line item.
  6. Responsible for communication with billing sources, clearinghouses, and the PAS department to problem solve issues as well as expedite claims management.  In addition, responsible for the quarterly creation of a write-off report for aged receivables
  7. Participate on PAS Billing/Accounts Receivable Team Meetings. Communicate regularly with staff and management on any issues with reimbursement or billing.
  8. Maintain an on-going knowledge of payor requirements as well as applicable contracts, regulations, and laws. Establish and maintain effective working relationships with carrier representatives.
  9. Ability to support and take directions from multiple supervisors in the accounting department.
  10. Document and track all work according to policy and procedure.
  11. Responsible for a variety of tasks associated with the operation of the accounting department and Independence First as a whole.

 

  1. Professional Qualifications:
  2. High School Diploma or equivalent.
  3. At least five years experience working with Wisconsin Medicaid, insurance eligibility, medical billing, and prior authorizations required.
  4. Have working knowledge of Sandata Software preferred.
  5. Experience with Excel, various insurance portals, UB04 formatting, and HMO requirements and guidelines required.
  6. Must be able to read and interpret insurance payor explanation of benefits and have experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
  7. Excellent organization and interpersonal skills as well as excellent written and verbal communication skills required.
  8. Strong analytical skills including ability to find errors and resolve them, read, analyze, and interpret general business periodicals, professional journals, or governmental regulations.
  9. Must be very detail oriented.
  10. Ability to be flexible and multitask to meet the changing needs of the department.
  11. Positive attitude and a team player.
  12. Experience in HCPC, CPT and ICD-10 coding; familiarity with medical terminology.
  13. Knowledge and ability to use computers, office equipment, and accounting software.
  14. Competencies needed include ethical conduct, strategic thinking, leadership, decision making, communication proficiency, and public speaking.
  15. Knowledge of Medicaid regulations in regards to the provision of Personal Care Services, as well as criteria for Medicaid Managed Care and Self Directed Supports, preferred.
  16. Transportation mobile or able to arrange own transportation.

 

 

  1. Work Environment
  2. Work environment is generally performed in an office setting with minimal to moderate noise level. 
  3. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.