Medical Billing Accounts Receivable Analyst

Physical Demands

Minimal in nature

Qualifications

• Associate degree preferred
• Three to Five years’ experience in Health Care Billing functions, preferably in a Behavioral Health and/or non-profit environment
• Ability to run reports necessary to correct and update billing and funding source data
• Ability to work with numbers and function with minimal supervision
• Experience and knowledge of Primary and Secondary insurance billing including the input of data, generation of electronic 837 billing files, and electronic and manual cash application of cash received from billings
• Possess the skills needed to interact with outside parties to collect the necessary information for the successful submission of claims

Specific Duties

• Complete all CBH Monthly and Weekly (CBE/PE) billing, including analysis to determine service type to bill and completion of roll-up services
• Rebill services from CBH to Medicare as required via HCFA 1500 forms and complete all relevant documentation
• Download, review and document all 277 files from CBH after each 837 file submission
• File TPL Discrepancies with CBH for all newly admitted or newly eligible Medicare clients who are dual-eligible and are receiving services from Russian-speaking therapists
• Download and post CBH 835 RA files including review, analysis, and correction of any incorrectly or unposted services
• Review, correct, and resubmit services rejected on the CBH 835 RA, or refer to A/R Manager for adjustments when indicated
• Review, correct, and resubmit services on the monthly CBH Open Services Reports, or refer to A/R Manager for adjustments when indicated
• Submit TPL Discrepancies to CBH for resolution
• Submit appeals for CBH services over 90 days as needed, and upload billing file with services within the required time frame when/if approved
• Review the CBH Unbilled Claims report on a monthly basis
• Generate and submit to DBH (Philadelphia County) all electronic requests for MHX Clearance for new Clients weekly
• Download and review the response file to the MHX Clearance submission
• Identify Clients that are ineligible for MHX Clearance for missing demographic data and flag in Avatar
• Follow up with Clinical Staff to obtain missing demographic data elements that prevent PATH from obtaining an MHX Clearance for the client, including missing Social Security Numbers
• Download the MHX Feedback Report on a weekly basis
• Identify and flag in Avatar Clients that have been newly approved for MHX Clearance for PATH on the MHX Feedback report
• Using source reports, create monthly Intake service charges to be billed to DBH
• Using source reports, create monthly Anonymous charges, and adjust clients’ services’ that will be billed as Anonymous
• Generate and submit billing files to DBH for Outpatient, CRR, BCM, and Administrative Case Management services by the end of the first full week of the month
• Download and review the ta1, 999, and 277 response files for the DBH billing two (2) business days of the submission of the 837 files
• Transfer 277 rejections into the DBH 277 workbook including the reason code(s) for rejection
• Analyze, correct, and resubmit DBH claims rejected on 277 files, or refer to the A/R Manager for adjustments
• Download the 835 RA for DBH within one (1) business day of its availability
• Document and calculate amounts approved by Program and/or age for DBH and enter in the DBH-OAS Approval Summary Workbook for the current Fiscal Year
• Analyze, correct, and resubmit DBH claims rejected on the 835 RA, or refer to A/R Manager for adjustments
• Review, confirm, and approve DHS services in the DHS Placement Verification System on the first working day of the month by 4:00 PM
• Follow-up and coordinate any corrections to DHS services with either DHS, RTF Clinical Staff, or both until the issue is resolved
• Review and resolve discrepancies on the Credit Balance report weekly
• Review the Service Code, Service Fee, Guarantor Definitions, and Program files in Avatar monthly to ensure accuracy in all areas
• Maintain a Cash Receipt Log by month
• Balance the Cash Receipts Log against the Monthly Posting report the first week of the month to ensure accuracy
• Resolve any discrepancies
• Provide back-up in assigned tasks for the Accounts Receivable Manager
• Aid in the training and on-going support of new Accounts Receivable staff