Job Description

Duties and Responsibilities

• Clean, review, and submit claims for behavioral health providers (specifically autism providers)
• Track claim statuses and remittances
• Work denials and follow up with unpaid claims proactively
• Manage patient responsibility invoices (e.g., patient co-insurance, co-pays)
• Evaluate insurance operations and identify efficiency improvements
• Analyze EOBs and post manual payments
• Submit and follow up on Commercial and Medicaid, primary and secondary insurances
• Communicate to administrative team for errors and corrections
• Work and manage claims from all aging buckets including posting and appeals, including resubmission of claims and appropriate adjustments.
• Input and review billing data for accuracy, including data entry.
• Ensure that billing and collections adhere to all compliance policies and procedures.
• Work with Billing Manager and local clinic team members to ensure accurate billing.
• Follows up on claim resolution from initial billing through final resolution including identifying and correcting billing errors/rejections and denials (denial management investigations & appeals).
• Manage claims submission and AR for assigned clinics.
• Process remittance advices/EOB’s to achieve finalized clean claims for payment including researching and correcting denials (Pull EFT back-ups).
• Post and reconcile payments received using system and deposit reports.

• Maintain confidentiality of all patient information.
• Perform other duties as assigned

Qualifications

• BS or BA degree in Finance, Accounting, healthcare administration or related field, preferred, and/or equivalent work experience in revenue cycle management or medical billing function
• 1 to 3+ years of experience in healthcare within revenue cycle management or medical billing function
• 1 to 3+ years of experience working with Medicaid and MCO’s within medical billing process
• Experience in a high growth and fast paced environments

Knowledge, Skills and Abilities

• Advanced level skills in the use of the Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook eMail and Calendar
• Strong mathematical and analytical skills
• Detail oriented and deadline driven
• Ability to read and analyze ERA remittances for appropriate posting and/or denial resolution actions
• Ability to apply current knowledge to more complex tasks in order to achieve elevated results, leading to continuous improvement
• Proven ability to work and collaborate with other team members and to maintain a positive attitude
• High level of integrity and dependability and the ability to manage multiple projects and competing priorities
• Ability to successfully complete required background and drug screens

Working conditions

Physical Conditions

• Ability to bend, kneel, crouch, and spend time standing as well as an ability to lift items up to 25 lbs.
• Endurance to move from a seated position to a standing position to accomplish required tasks
• Requires eye-hand coordination and manual dexterity enough to operate office equipment, etc.
• Ability to effectively communicate both orally and audibly using a variety of software communication platforms and electronic devices