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Billing Specialist

Open Systems Healthcare Philadelphia, PA Full-Time
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Position Overview: Responsible for ensuring Open Systems Healthcare's compliance with all aspects and levels of Federal, State and local laws, regulations and standards within the realm of Accounts Receivable. Collects both Private and Medicaid reimbursements by resolving discrepancies, adjusting claims, preparing reports, monitoring collections, and provide excellent customer service to internal staff and designated payers.

Essential Job Functions:

  • Resolves a high volume of disputed claims by gathering, verifying, and providing additional information; following-up on claims.
  • Monitors collections of receivables.
  • Monitor and resolve AR report receivables over 90 days old.
  • Monitor, process, and resolve appeals of receivables.
  • Monitor timely filing deadlines for each designated payer and ensure processing is completed in that timeframe.
  • Correct claims when errors occur (ex: ICD-10, Authorization number, etc).
  • Collaborate with branch office(s), claims processors, and Billing Department to ensure collection and resolve disputes throughout the lives of claims.
  • Maintains, develops and updates essential billing records.
  • Assists in preparation of reports required by regulatory agencies as directed by the Medical Billing Supervisor.
  • Gathers both private and Medicaid billing information by reviewing consumer records.
  • Resolves discrepancies by examining and evaluating data; identifying corrective steps.
  • Examine, process, calculate and pay claims insuring filings, documentation and reports, etc.
  • Enter codes and verify data for computer processing.
  • Locate and notify designated payers of delinquent accounts by mail, telephone, email, or personal visits to solicit payment.
  • Answer designated payer questions regarding problems with their accounts.
  • Record information about financial status of designated payers and status of collection efforts.
  • Sort and file correspondence and perform miscellaneous clerical duties, such as answering correspondence and writing reports.
  • Performs all other duties as required and assigned by Administrator and/or Supervisor.
  • Follows Open Systems Healthcare's Policies and Procedures.
  • Follows Federal, State and local laws and regulations pertaining to home care services
  • High School Diploma or GED equivalency, preferred.
  • 2+ years' experience in medical billing, receivables, payroll, or data entry in the home health industry required.
  • Experience with Microsoft Office, QuickBooks, preferred.
  • Must have a reliable form of transportation.
  • Teamwork: Works collaboratively together with others to achieve group goals and objectives
  • Accountability: Takes personal responsibility for the quality and timeliness of work and actions, and achieves results with little oversight.
  • Conscientious: Conscientious in work ethic and interpersonal management
  • Motivation: Focuses on results and desired outcomes and how best to achieve them. Gets the job done.
  • Complex Problem Solving: Resolves difficult or complicated challenges.
  • Development and Continual Learning: Displays an ongoing commitment to learning and self-improvement.

Preferred Competencies:

  • Able to work in a fast paced work environment.
  • Ability to effectively communicate externally as well as internally with all levels of the organization.
  • Focus on Consumer Needs: Anticipate, understand, and respond appropriately to the needs of internal and external customers to meet or exceed their expectations within the organizational parameters.
  • Ability to handle confidential information in compliance with HIPAA.
  • Ability to handle sensitive information in a calm and professional manner.
  • Ability to lead change and innovation.
  • Ability to manage multiple tasks on a daily basis and manage time efficiently.
  • Public relations ability, interpersonal skills and professional telephone manner.
  • Resourcefulness
  • Technical Capacity.
  • Professionalism.

Work Environment and Physical Demands:

  • Ability to perform tasks involving physical activity, which may include light moving and extensive self-positioning.

Open Systems Healthcare, Inc is an EEO Employer: All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, sex, religious creed, disability or any other category protected under law.

Recommended skills

Claims
Collections
Authorization (Medical)
Appeals
Team Working
Medicaid
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