As a member of the Revenue Cycle Team, the Billing and Accounts Receivable Specialist is responsible for the accurate and timely billing of services, to Medicare, Managed Care, Medicaid and Motor Vehicle claims. Posting of payments, verification of authorizations, claims resolution and accounts receivable follow-up of outstanding balances.
Ensure timely, accurate and efficient processing and submission of all electronic 837 invoices and paper claims/invoices to funders.
Perform insurance eligibility; correctly utilize ICD diagnosis codes, CPT/HCPC codes and modifiers to ensure accurate and timely payments.
Utilize knowledge of the pre-certification and authorization process to ensure all certifications and authorizations are valid and accurate.
Enter and maintain authorizations in the Electronic Health Record.
Ensure compliance with billing practices, policies and procedures by leveraging strong knowledge of the policies and rules stipulated by Medical Assistance, Managed Care, Third Party, Auto Liability, Private Pay and various school districts.
Verify client eligibility and funding changes.
Track and report residential changes that may impact reimbursement.
Timely submission of claim corrections and resubmission of invoices and claims when necessary.
Maintain client billing records.
Accurate posting of payments in the billing system to appropriate client accounts within five business days of receipt.
Accounts Receivable Duties:
Identify and resolve unpaid claims and report issues to supervisor.
Weekly monitoring and monthly reporting on the status of accounts receivable over 30 days in arrears, provide details of collection efforts and issues with securing reimbursement.
Perform collection actions including contacting funders, clients and guarantors by phone, email, and mail.
Provide exemplary customer service to external stakeholders and internal clients.
Work collaboratively with other departments and programs to gather and provide information on authorization and eligibility issues.
Maintains quality results by following established policies and procedures.
Share knowledge of current regulations, policies and developments with team members and other stakeholders.
Maintain strict confidentiality with regard to all client information. Adheres to all HIPAA guidelines/regulations.
Demonstrate a strong commitment to performance accountability.
Respond to inquiries from funders and Woods management staff regarding billing and account related matters.
Attend relevant seminars and training sessions to improve knowledge, skills and performance as specified by the Billing Supervisor or the Revenue Cycle Manager.
Other duties as assigned by the Billing Supervisor or the Revenue Cycle Manager.
Associates Degree preferred. Individuals with billing experience in a healthcare environment and a high school degree will be considered in lieu of a degree.
Minimum three years work experience relevant to the duties and responsibilities of the position required.
A high level of experience with Medicare, PA Medicaid, Managed Care and Third Party funders, including coordination of benefits. Previous experience with computerized billing software and healthcare billing strongly desired.
Strong interpersonal skills and a solid work ethic.
Excellent organization and communication skills, clerical and numerical proficiency and familiarity with Windows-based software application packages.
Demonstrate the ability to handle multiple tasks, adhere to established deadlines, and produce work that consistently meets or exceeds team benchmarks.
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Job ID: 2019-2741
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Woods is a leading advocacy and service organization for people with exceptional challenges, disabilities and complex needs.
We were founded a century ago by visionary Mollie Woods with two simple goals – to advance the quality of life and standard of care for individuals with disabilities. She gained international recognition for her groundbreaking work in helping children with exceptional needs experience the joy of achievement and lead fulfilling lives.