PruittHealth · 1 week ago
Medicare Billing and Collections Specialist
Norcross, GA
Full-time
Onsite
Entry Level
1+ years expPruittHealth is a healthcare organization seeking a Medicare Billing and Collections Specialist. The role involves supporting insurance billing services, ensuring timely and accurate claims processing, and conducting follow-ups on payment delays to maximize reimbursement.
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
Required
Supports the delivery of all Insurance billing services by final/higher level auditing, correcting, and submitting claims
Ensures that billing services are timely, accurate, and allow for appropriate reimbursement
Conducts all claims-related follow up on payment delays, taking corrective action(s) to finalize account disposition and/or referring claims to the appropriate staff to ensure appropriate reimbursement in the timeliest manner possible
Conducts month-end close and cash posting responsibilities for all assigned locations
Functions within a team environment and under general supervision
Manages a volume of work as established by PruittHealth productivity performance standards
Familiar with the rules and regulations of Insurance billing
Skilled at problem solving and account resolution
Works well within a team and helps foster an environment where continuous improvement in business processes and services is welcomed and recognized
Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims
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
Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through
Conducts account follow up including the investigation of payment delays to appropriately maximize reimbursement
Applies knowledge of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources
Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals
Responds to inquiries, complaints or issues regarding patient billing and collections
Participates in cross-training and job enlargement opportunities for major job responsibilities
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
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
Assists in orientation and appropriate training of team members
Maintains positive work relationships with members of own and other teams
Carries out all duties with a 'Commitment to Caring' attitude in accordance with PruittHealth's mission, vision, and philosophy
In-depth knowledge of various billing documentation requirements, the patient accounting system, and various data entry codes
Knowledge of insurance and governmental programs, regulations and billing processes
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
Ability to execute strategy and communicate knowledge of business processes and enabling technologies
Ability to comprehend and retain information that can be applied to work procedures
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
Strong relationship-building and communication skills (verbal and written)
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
Ability to securely access and use protected health information
Preferred
AA/AS in Accounting or Business (or Equivalent Education / Experience) preferred
Company
PruittHealth
PruittHealth is a Southeast regional leader in long-term health care.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Randall Loggins
Chief Financial Officer
Recent News
2025-11-01
2025-10-31
2025-08-29
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