Job Description

Manage daily billing functions for assigned patient insurance companies. Coordinate the interaction between patients and payors to facilitate timely reimbursement. Serve as a point of contact for billing problem solving. In depth knowledge of carrier Clinical Coverage Policies (CCP) and Billing Coverage Policies (BCP).

SPECIFIC RESPONSIBILITIES:

• Maintain Accounts Receivable KPI (A/R balances older than 120 days must be less than 19% of total A/R)
• Maintain Adjusted Collection Percentage KPI (Reimbursement/Collections equal to or above 97% of Expected)
• Review and resolve denied patient insurance claims
• Assist in identifying current and/or potential billing issues specific to unpaid claims
• May post and balance activity from carrier remits to include payments, contractual adjustments, and other adjustments
• May post and balance payments from patients
• Make appropriate decisions and calls to carriers to maximize reimbursement on accounts to be worked
• Correct errors on electronic error reports
• Process and print/transmit patient insurance claims, bills and other reports.
• Respond to patient account inquiries in person, by phone, or by mail; resolve problems as necessary
• Respond to inquiries from office staff regarding patient charges, appropriate diagnosis coding, and insurance coverage related issues
• Respond to inquiries from employees, payers, and patients regarding CPT and ICD-10 codes
• Maintain high level of patient confidentiality
• Ensure compliance with HIPAA regulations
• Other duties as assigned

This role description is a general description of the essential job functions. It is not intended to describe all the duties the Denial Specialist may perform.

KEY COMPETENCIES:

• Communication Skills Effectively and respectably communicate with other individuals, whether it be a colleague, patient, or patient’s family member and appropriately enumerate information in a manner easily understood by all parties. We do this to foster a culture of understanding between all parties, especially in complex and difficult situations, to ultimately provide the best care possible to our patients and their families.

• Decision Making Ability to make the most appropriate decision in a given situation and then taking the next steps to ensure appropriate and timely completion. This requires conflict resolution skills, critical thinking skills, confidence in your ability to make the right decision in most situations. This also includes ability to prioritize your workday appropriately to ensure the most important tasks are completed on time.

• HealthCare Knowledge Having the drive to keep yourself abreast and up to date on the new breakthroughs in your area of expertise and communicating them to the rest of the team, as appropriate. This also includes keeping up with your licensure and yearly training requirements within your area expertise along with MAHEC’s organizational training. Finally, the ability to apply the depth of knowledge maintained and gained through this process in real life scenarios as appropriate.

• Interpersonal Skills Showing the ability to meet difficult situations with grace, professionalism, and understanding. Within your area of expertise, showing respect and showing empathy where appropriate with your colleagues, patients, and their family at all times, even when its most difficult to do so. This is done, in part, by effective listening, being your authentic self, showing responsibility and dependability, and being patient with others.

• Organizational Values Adherence to MAHEC’s founding principles and incorporating them every day. This includes, among others, having integrity and accountability, reverence for other cultures and equitable practices, ability to manage change, and displaying a clear understanding of organizational dynamics. Doing these things creates a culture where people want to do the best for each other and gives personal ownership towards the goal of helping people in their time of need.

• Problem Solving Having an analytical mind and ability to work autonomously to solve complex problems that may arise. The wherewithal to think logically through a difficult problem and come to an appropriate resolution for a given issue. This helps to drive continuous improvement by thinking through where we can improve in a novel way. Measures success by understanding where we are currently and where we want to go and then applying those new ideas to affect positive change.

SPECIFIED SKILLS

COMPUTER

• Excellent skills in Microsoft Office including Word, Excel, PowerPoint, and database applications required.

FOREIGN LANGUAGE

• Spanish speaking skills preferred.

PHYSICAL DEMANDS

• Not Applicable.

EDUCATION AND EXPERIENCE

MINIMUM QUALIFICATIONS:

• High School Diploma or GED equivalent required

PREFERRED QUALIFICATIONS:

• One (1) year of relevant billing experience preferred

SCHEDULE:

Regular attendance on-site at our Westridge Enka/Candler location is an essential function of this position. Typical business hours are Monday – Friday, 8:00 am to 5:00 pm (or flexed to best meet the needs of the clients and/or the Division); 40 hours per workweek; weekend, holiday, or evening coverage is occasionally required. Work hours will need to be flexible in order to respond to special work assignments, or evening activities, as requested by the team leader.

POSITION COMPENSATION:

$23.65/hour, full time + full benefits

At MAHEC , we strive to equip all team members with Total Rewards (pay + benefits) to honor their service, support their health, manage their financial security, build their career, and thrive.

All MAHEC employees and learners will be required to receive the Flu vaccine or have an approved exemption.

MAHEC Talent Management is located at 121 Hendersonville Road, Asheville, NC 28803. Equal Opportunity Employer.