Medical Claims Specialist
11 hours ago
We are seeking a highly skilled Billing and Collections Specialist to join our team. As a key member of our revenue cycle team, you will play a crucial role in managing third-party billing and collections functions for assigned accounts.
This is a remote position that offers flexibility and convenience. If you have experience processing skilled nursing medical claims with third parties, including Medicare, Managed Care, and Insurance Companies, and a proven track record of successful collections, we want to hear from you.
Responsibilities- Coordinate the accumulation of information with various departments; post to resident accounts.
- Review charges for accuracy, completeness, consistency, and payers charged.
- Prepare and timely issue accurate billing statements to the correct payer using electronic systems provided.
- Monitor all submissions on a daily basis to address any denials or requests for additional information (ADRs).
- Follow up on unpaid claims/denials within company standard billing cycle timeframes; determine reasons for denial. Correct claims and re-bill when required.
- Document all communications and collection attempts, taking follow-up action in accordance with established policies and procedures.
- Provide needed supporting documentation to payer upon request in a timely manner.
- Maintain A/R Aging levels for assigned accounts within company guidelines.
- Notify supervisors of difficult/problem accounts; residents unwilling or unable to pay balances.
- Process claim reclassification to private accounts upon approval from management.
- Process bad debts in a timely fashion when claims are determined to be uncollectable. Document all reasons for uncollectability and efforts in the process.
- Apply Third Party payments daily, including checks, wire transfers, EFT payments, other bank deposits, cash, and credit card payments. Confirm completeness and accuracy of payment information to the residents' accounts.
- Establish good relationships with all third-party payers through professional communication.
- Efficiently conduct inquiries and analysis for resolution of discrepancies.
- Two to three years of experience processing skilled nursing medical claims with third parties, including Medicare, Managed Care, and Insurance Companies, with a track record of successful collections.
- One or more years of experience working in a high-volume, short-term rehab environment.
- Knowledge of billing and related software preferred and/or experience with similar software.
- Proficiency with Microsoft Office and ability to learn company IT systems.
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