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PruittHealth · 1 day ago

Medicare Billing and Collections Specialist

Georgia-NORCROSS

Full-time

Onsite

Entry, Mid Level

1+ years exp

PruittHealth is a healthcare organization that is seeking a Medicare Billing and Collections Specialist. The role involves supporting insurance billing services through auditing, correcting, and submitting claims, while ensuring timely and accurate billing for reimbursement. The specialist will also conduct follow-ups on payment delays and manage accounts receivable for assigned community services facilities.

Health CarePersonal HealthWellness

Responsibilities

Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims, with the objective of receiving appropriate reimbursement based upon services delivered and ensuring that the claim is paid/settled in the timeliest manner possible

Works with assigned community services facilities’ administrators and office personnel to manage relevant accounts receivable

Edits claim forms, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct diagnosis, and procedure codes are utilized

Submits Insurance claims, including the maintenance of bill holds and the correction of errors, to provide timely, accurate billing services

Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions

Conducts account follow up including the investigation of payment delays to appropriately maximize reimbursement based upon services delivered and ensuring claims are paid and settled in the timeliest manner

Applies knowledge of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to research payment variances, make corrections, and take appropriate corrective actions to ensure timely claim resolutions

Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect

Responds to inquiries, complaints or issues regarding patient billing and collections, either directly or by referring the problem to an appropriate resource for resolution

Participates in cross-training and job enlargement opportunities for major job responsibilities. Works with direct supervisor to identify minor set of responsibilities to develop and perform

Plans, organizes, and documents work to deliver business results by meeting or exceeding all individual operating metrics and service line agreement objectives

Follows all PruittHealth policies and procedures, state and federal laws and regulations and report violations and potential issues to his/her team leader as appropriate

Contributes ideas and actions towards the continuous improvement of Revenue Cycle processes

Adapts to learning new processes, concepts, and skills; Seeks and responds to regular performance feedback from team lead and provides upward feedback, as needed

Assists in orientation and appropriate training of team members, including helping cross-train peers in minor responsibilities and acting as a mentor to peers

Maintains positive work relationships with members of own and other teams to communicate effectively and ensure compliance with cross-team responsibilities

Carries out all duties with a 'Commitment to Caring' attitude in accordance with PruittHealth’s mission, vision, and philosophy

Qualification

Insurance Claims ManagementMedical BillingPatient Accounting SystemsData EntryMicrosoft Office SuiteMedical TerminologyProblem SolvingCommunication SkillsTime ManagementTeam Collaboration

Required

AA/AS in Accounting or Business (or Equivalent Education / Experience) preferred

Demonstrates experience and a proven track record in Insurance Claims in a medical setting of moderate size and complexity, information systems, and patient accounting applications, as typically acquired in 1-3 years of patient accounting / medical billing positions

Experience in month end close activities and reconciling cash received to the patient accounting system

In-depth knowledge of various billing documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of patient accounts

Knowledge of insurance and governmental programs, regulations and billing processes, commercial third-party payers, and/or managed care contracts and coordination of benefits

Familiarity with medical terminology and the medical record coding process

Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections

Familiarity with Insurance Claims management functions in non-acute settings

Knowledge of Patient Management information system applications, preferably MatrixCare, as well as spreadsheet, word processing, and other basic Microsoft Office Suite applications

Ability to execute strategy and communicate knowledge of business processes and enabling technologies, specifically in an Insurance Claims function

Ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery

Data entry skills (minimum 50-60 accurate keystrokes per minute)

Strong accuracy, attentiveness to detail and time management skills

Ability to conceptualize, plan, and implement stated goals and objectives

Ability to work concurrently on a variety of tasks/projects in an environment that demands a high degree of accuracy and productivity in cooperation with individuals having diverse personalities and work styles

Strong relationship-building and communication skills (verbal and written) in dealing with other team members and internal/external customers to expedite the patient accounting process

Excellent ability to identify, prioritize, resolve and/or escalate complex problems promptly

Ability to learn new applications/software systems effectively and efficiently

Ability to communicate ideas both verbally and in writing to interact with others using one-on-one contact, formal presentations, and group discussions

Ability to securely access and use protected health information (all medical record information) to perform the functions outlined as part of this position description