Medical Billing & Collections Specialist | eKidzCare

Corporate Positions

  • Sewickley, PA
  • Permanent
  • Full-time
  • 18 days ago
eKidzCare is seeking an experienced medical billing and collection specialist for our office in Sewickley, PA. The candidate must be comfortable with reconciling patient collections.JOB SUMMARY:The medical billing and collection specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicaid Managed Care, commercial insurance payers, private pay, and school contract payers. The medical billing and collection specialist must possess critical thinking skills and an understanding of Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments based on payer contracts or government regulations. In addition, the medical billing and collection specialist must demonstrate proficiency with the billing system to ensure all functionality is utilized for the utmost efficient processing of claims. Candidate must be comfortable with this position being 75% collections.MAJOR DUTIES & RESPONSIBILITIES:
  • Responsible for charge and payment entry within Electronic Health Record. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/ claim adjudication;
  • Responsible for correcting, completing, and processing claims for all payer codes;
  • Analyze and interpret that claims are accurately sent to insurance companies;
  • Perform follow-up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports;
  • Process appeals online or via paper submission;
  • Assist in reconciling deposit and patient collections;
  • Assist with billing audit-related information;
  • Process refund requests;
  • Attend provider meetings/ workshops when needed;
  • Communicate with billing and credentialing coordinator to identify and resolve audit review issues;
  • Answer/respond to correspondence related to patient accounts. Is available to answer billing and changes-related inquiries by patients, staff, Managed Care Organization, etc.;
  • Communicate daily with internal and external customers via phone calls and written communications;
  • Identify trends, and carrier issues relating to billing and reimbursements. Report findings to Team Lead and/or Supervisor;
  • Research, record findings, and communicates effectively with Manager to achieve optimum performance;
  • Pursue and participate in education to remain current with changes in the Healthcare industry;
  • Perform other duties as assigned to support ePeople’s Mission, Vision, and Values.
QUALIFICATION REQUIREMENTS:
  • Proficient knowledge of PA Medicaid, Managed Care and commercial health care plan billing & collection practices
  • Minimum of two years of related experience in a business, medical or technical environment;
  • Previous experience in a medical office setting and/or experience with an Electronic Medical Record a plus;
  • Customer service driven;
  • Understanding of medical terminology and insurance laws/guidelines;
  • Excellent organization and time management skills along with excellent oral and written communication skills;
  • Strong team player;
  • Ability to learn quickly, build and maintain long-term relationships and work with minimal supervision;
  • Strong written and verbal communication skills; strong analytical, organizational and time management skills required.
EDUCATION and/or EXPERIENCE:Associate Degree preferred. Certified Biller and Coder strongly preferred.LANGUAGE SKILLS:Ability to read, analyze, and interpret general health and social services guidelines, technical procedures or governmental regulations. Ability to write reports, health correspondence and procedure manuals. Ability to effectively present information and respond to questions from groups or patients, center staff, and the general public.MATHEMATICAL SKILLS:Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent.REASONING ABILITY:Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.LEADERSHIP RESPONSIBILITIES:No supervisory or direct people management responsibilities. May provide occasional work guidance, technical advice, and training staff.WORK COMPLEXITY/INDEPENDENT JUDGEMENT:Work tasks are often straightforward, routine, structured and guided by established policies and procedures. Little, if any, independent judgment is required, outside of making basic choices in the selection and application of established methods. The job received frequent, ongoing supervision.PROBLEM-SOLVING:Decisions are made on routine matters affecting few individuals and usually within the confines of the job's own department. Specific job activities and results are typically reviewed closely. There are limited requirements for developing new ideas or changes in methods, procedures or services.COMMUNICATION/INTERACTIONS:Information sharing - gives and receives information such as options, technical direction, instructions and reporting results. Interactions are mostly with customers, own supervisor and coworkers in own and other departments.IMPACT OF DECISIONS:Follow rules and procedures. Decisions can have minimal or no impact to eKidzCare. Errors can be readily detected, usually by the employee, and, if made, would result in minor expense for correction.CUSTOMER RELATIONSHIPS:Follow through with customer inquiries, requests and complaints. Forward difficult and nonroutine inquiries or requests to the appropriate level for resolution.*Pay rate is subject to change based on skills and experience*IND7#zrcorp

Corporate Positions