Medical Claims Specialist

Job Opportunity

We are seeking a skilled professional to assume the role of a Billing and Collections Specialist. This position will be responsible for managing all Third Party billing and collections functions for assigned accounts in the revenue cycle.

The ideal candidate will have experience processing skilled nursing medical claims with third parties, including Medicare, Managed Care, and Insurance Companies. A track record of successful collections is essential.

Key Responsibilities

• Coordinate the accumulation of information from various departments and post it to resident accounts.
• Review charges for accuracy, completeness, consistency, and payers charged.
• Prepare and 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).
• Coordinate with all departments and submit ADR information within 10 days of receipt of request.

Collections Focus

• 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.

Cash Application

• 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.

Customer Service

• Establish good relationships with all third-party payers through professional communications.
• Efficiently conduct inquiries and analysis for resolution of discrepancies.

General Requirements

• Adhere to the highest practical standards in policy and procedure adherence.
• Participate in and maintain current status on all training and education required by the organization.
• Communicate effectively with all members of the staff and business partners.
• Provide feedback to others for continuous quality improvement of the entire organization.
• Openly accept feedback from others for the continuous quality improvement of the entire organization.
• Escalate issues when there is an appearance that business standards of quality are not present.
• Comply with all rules and regulations of the organization, including HIPAA and safety.
• Perform other duties as assigned.

Requirements and SpecificationsEducation and ExperienceRequired

• 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 organization IT systems.

Preferred

• MatrixCare/Answers on Demand and Ability experience is a plus.

Essential Qualifications

• Strong communication, interpersonal, and organizational skills.
• Detail orientation.
• Ability to manage multiple priorities.
• Discretionary judgment.
• Ability to work independently and as part of a team.

Language Skills

• Ability to read, write, and speak English proficiently.

Benefits

This opportunity offers a flexible remote working environment, collaboration with an international team, and contribution to a growing business from the comfort of your home.

You will need to have some essential tools – a reliable computer and noise-canceling headset, a second monitor for enhanced productivity, and a stable internet connection. You'll also be required to have a backup internet connection, ensuring that you're well-equipped to complete your work seamlessly.

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