Job Description:
• Collect all the necessary information to prepare claims, coordinating with agencies when appropriate.
• Bill and submit clean claims electronically and follow up with the Payer.
• Process, collect, and manage account payments.
• Monitor claims daily, report totals.
• Research, correct, and re-submit rejected and denied claims.
• Follow-up on corrections and report adjustments by utilizing revenue cycle management tool.
• Monitor and maintain assigned accounts.
• Review billing reports to maintain accurate AR balances.
• Document all follow-ups completed on the claim outstanding balance until the final resolution is reached.
• Keep accurate and orderly records for all billing and accounts receivable activity.
• Pre-billing audits as assigned.
• Proactive in identifying potential reimbursement issues while ensuring effective problem resolution.
• Coordinate with the Agency and Billing Compliance Coordinator on any relevant process issue impacting billing to establish a resolution.
• Report any billing issues that develop into trends to the immediate supervisor.
• Answer questions from patients, agency staff, and insurance companies.
• Interpret and process Explanation of Benefits when needed.
• Professionally make outbound calls, while keeping and improving customer relations.
• Maintain knowledge of current industry standards related to billing, cognizant of new regulations that impact billing.
• Prepare and implement any required change accordingly.
Requirements:
• Required Private Duty billing experience.
• Required Authorization request experience.
• Preferred, AlayaCare, Waystar, Availity experience.
• Ability to communicate effectively both verbally and in writing.
• Excellent customer service skills.
• Private Duty billing and denial management skills, including VA.
• Excellent PC skills, Email, Internet Research, Word Processing, Spreadsheets, PDF, and Patient Accounting software systems knowledge (preferably CareVoyant).
• Reviews and maintains reports and records to ensure accuracy.
• Knowledge in accessing the payer portals and reaching out to payers.
• Claims preparation and audit, including prebill audits for billing compliance.
• Knowledge of billing regulations and claim submission.
• Detail-oriented and effective in problem resolution and escalation.
• Able to organize duties and functions in a highly effective manner to achieve productivity and quality standards.
• Knowledge of regulations and publications for Private Duty, skilled and unskilled care.
• Ability to post payments and follow up on discrepancies in payments.
Benefits:
• Competitive pay
• 401k
• health & life insurance
• Flexible schedules & career growth opportunities
• Continuing education & recognition programs
• Supportive, family-like team culture
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