Billing and Reimbursement Specialist JobWallingford, CT 130077

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Why You'll Love This Job

Are you interested in joining a dynamic company that delivers successful in home treatment to clients with substance use disorder? If you are a caring, compassionate and capable Billing and Reimbursement Specialist who meets or exceeds the following, we want to hear from you!
 
Position Summary:
The role of the Billing & Reimbursement Specialist is to analyze the claim submissions and billing process to determine appropriateness and accuracy. The Billing & Reimbursement Specialist is responsible for handling claims processing including Accounts Receivable aging/collections and reviewing returned, disputed or rejected claims from commercial payers.

Position Highlights
  • This role is hybrid out of our Florida Office located in Delray, FL.
  • Expectation is a minimum of 2 days in the office. *The initial 30 days may require additional in office time for training*
  • This role is full-time non-exempt with a starting rate of $21-$24/hour
Benefits Highlights
Coverage: Health, vision and dental through Anthem Blue Cross Blue Shield, FSA, HSA that comes with an employer match, along with STD, LTD, life insurance, EAP, and more.
Balance: Competitive front loaded Paid Time Off (PTO) plan , 8 paid Holidays, 1 paid floating Holiday of your choice, and 1 day off for your birthday.
Development: Certification/continuing education eligibility, leadership development and 1 paid day off a year to go towards personal professional development.
Retirement: 401(k) retirement plan with 50% employer match up to 4%
Culture: Great Place to Work certified #GPTW, dedication to diversity, equity and inclusion, and a growing working environment.
*In order to be eligible for our full benefits package you must be employed full time at a minimum of 32 hours a week*


Aware Recovery Care is an Equal Opportunity Employer


Responsibilities

ESSENTIAL FUNCTIONS:

  • Ability to assess and track why payments are being billed incorrectly and appropriately create mitigation strategies to reduce additional risks.
  • Work with external and internal staff to ensure on getting all claims paid in a timely manner.
  • Obtain reimbursement from responsible parties by direct contact as needed to facilitate reimbursement.
  • Manage a large number of accounts and claims.
  • Ability to work 300 minutes on the phone/portal for claims adjudication.
  • Manage claims via multiple platforms and systems.
  • Ability to negotiate claims and resolve claims with external agencies.
  • Ability to identify Verification of Benefits (VOB) issues as it pertains to claim resolution  and resolve the issue or report the issue.
  • Ability to assist with cash posting, posting charges, and/or assist with daily, weekly and monthly closing, as needed.
  • Run claims, and cash posting reports daily, weekly, monthly and quarterly as assigned.
  • Identify and communicate with payer and/or system trends to Management regarding unpaid claims, denials, reimbursement issues, etc.
  • Maintain thorough knowledge of payer contract, regulations and guidelines, as well as State and  Federal laws relating to reimbursement procedures to ensure accurate and compliant billing processes.
  • Take initiative and action to respond and resolve customer billing and reimbursement inquiries  in a timely manner.
  • Initiate payer disputes, initiate appeals and exhaust all internal collection efforts.
  • Make recommendations for collection trends.
  • Outbound phone calls to payers.
  • Outbound phone calls to clients.
  • Collect on accounts and troubleshoot all inquiries from the organization and  other entities based on insurance carrier information rules and regulations.
  • Accountable for outstanding customer service that drives quality and an exceptional customer experience.
  • Adapts to organizational change and departmental restructuring to fit the needs of our clients and payer sources.
  • Perform miscellaneous job-related duties as assigned.

Skills & Qualifications

Education:
  • High School Graduate or GED equivalent

Experience:
  • Minimum two years of previous healthcare billing and reimbursement
  • Knowledge of CMS 1500, CPT codes and ICD-10
  • Knowledge of 837 billing processes and 835 processes

Computer Skills:
  • Proficient keyboarding and computer skills including word processing, spreadsheet, and Client Accounts software

Key Competencies:
  • Exceptional organizational and leadership skills
  • Efficient work ethic
  • Ability to easily adapt and multitask
  • Strong ability to collaborate and perform in a team-oriented environment as demonstrated by prior experience
  • Professional and proficient written and verbal communication
  • High level of integrity and professionalism
  • Goal and results oriented
  • Resilient and able to perform under pressure
  • Critical thinker
  • Reliable
  • Strives for excellent standards of quality
  • Entrepreneurial spirit
  • Commitment to ongoing learning and growth
  • Ability to use electronic health records, phone systems, customer resource management software, and more general office computer systems
  • Appreciation and respect for principles of diversity, equity, and inclusion. Ability to engage with diverse audiences (age, gender, nationality, race/ethnicity, profession, etc.)
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