Billing & Collect Coord - Home Care - FT

Responsibilities

• Accountable for overall accounts receivable responsibilities including but not limited to billing, posting, collections and account analysis.
• Confirm Delivery Tickets and review associated charges for accuracy.
• Review payer contracts and ensure updates to fee schedules are inputted into the EMR system and activated timely to ensure proper pricing of all charges.
• Process assigned payer billing daily.
• Generate source reports in EMR system, reviews charges for accuracy and alignment with payer contracted rates to reduce denials.
• Transmit billing batches electronically via clearinghouse and confirms acceptance of all submitted batches.
• Investigate all billing problems and initiate correction if applicable.
• Work to resolve billing issues with Medicare, Medicaid and insurance companies.
• Follow up to ensure corrections are completed.
• Complete posting of payer remittances and patient payments in an accurate and timely manner.
• Complete and process all hard copy denials into the EMR system within 48 hours of receipt.
• Process adjustments timely and with the authorization from the Administrative Manager.
• Process all recertification Certificates of Medical Necessity (CMN) and send them to physicians' offices.
• Assure CMNs are returned accurately and complete prior to the due date.
• Process requests for all renewal prescription requests to physician offices.
• Assure all renewal prescription requests are returned accurately and complete prior to due date to reduce held claims for billing.
• Process all reauthorization requests to insurance payer with required medical necessity documentation two weeks prior to current authorization expiration.
• Assure all reauthorizations are received back to prior to due date (expiration) and inputted into the EMR system.
• Review open AR in EMR system daily and process and work denied claims via appropriate method (appeal, corrected claim, etc.) for resolution as defined by payer provider manual, and prior to expiration of payer timely filing for appropriate resolution method.
• Maintain AR for assigned payer(s) at or below benchmarks and at an appropriate level.
• Assure DSO is at an acceptable level as indicated by the organization benchmark.
• Review difficult collection issues and work with multiple resources including payer special project teams and internal HMH revenue cycle escalation team to resolve open AR issues timely with payers.
• Complete all matrix reports daily and review with Manager on a weekly basis.
• Maintain and update shared payer coverage documentation to assist Customer Service Department with ensuring referrals meet payer guidelines for coverage.
• Communicate payer changes to coverage guidelines to Customer Service Supervisor and Customer Service Representatives regularly and timely as necessary.
• Resolve voicemail messages daily.
• Work on correspondence daily.
• Complete filing and review mail upon supervisor`s request.
• Answer phone promptly and in a courteous, professional manner.
• Assure accurate and complete phone messages are taken and relayed to the appropriate party.
• Interact with patients in a professional manner, explaining any billing questions, and collecting open patient balances.

Qualifications

• High School diploma, general equivalency diploma (GED), and/or GED equivalent programs
• Minimum of two (2) years of Billing and Collections experience
• Strong analytical skills
• Strong customer service skills
• Proficiency in Microsoft Office applications and/or Google Suite applications