Billing and Reimbursement Specialist

4 weeks ago

Manchester, United States Amoskeag Health Full time

Amoskeag Health is a Federally Qualified Health Center (FQHC) and progressive, nonprofit primary healthcare organization that celebrates its 30th year in 2023_

Our team of healthcare professionals positively impacts the health, well-being and quality of life for those we serve providing comprehensive, integrated, affordable healthcare and education to patients. We utilize a team-based model including embedded Behavioral Health Clinicians as well as Case Managers, Care Coordinators and Community Health Workers.

The Billing Specialist is responsible for various aspects of the revenue cycle process. This position primarily supports the Billing Office for Amoskeag Health. This position promotes revenue integrity and accurate reimbursement for the organization by ensuring timely and accurate billing, special projection completion and collections of accounts as assigned. This position requires a high-level of analysis, attention to detail, and good verbal and written communication skills to address provider and insurance related inquiries, denials, payments, with the ability to document account activity.

**This is a 6-month temp to perm position with remote work consideration.**

**Qualifications**
- Education/Training: HS diploma or GED.
- Excellent communicator with demonstrated flexibility, motivation, and positive attitude.
- **Required**: Minimum three-year Healthcare Billing experience required.
- **Required**: NH Medicaid billing experience.
- Preferred: Experience in AthenaOne EMR
- Knowledge/Skills: Basic computer skills to bill claims, document, and edit patient account information. Ability to work independently, decision making ability, strong interpersonal communication skills, strong organizational skills, attention to detail and follow-through.

**Compensation**: The pay range for this position is $18.00 - $26.94 per hour. **At the time of an offer, determination of your rate will reflect your skills and experience as it relates to the position.**

**Responsibilities**:

- Ensures that all claims are reviewed daily and submitted electronically in a timely manner using the claims management system.
- Reviews all claim edits/claim rejections and makes the necessary corrections ensuring compliance with all federal, state, and specific commercial payer requirements.
- Works claims in an on-hold status to ensure timely billing practices.
- Coordinates data requests with other departments in support of timely billing. (Medical Records/Intake/Provider Orders or Referral Center/Quality Review)
- Prepares and submits manual paper claims as needed to third party payers who do not accept electronic claims or who require special handling.
- Utilizes resources available to monitor outstanding claims for assigned payers (Work Queues/Aging Reports) and ensures claim follow-up does not exceed payer filing limits.
- Initiates re-billings, corrected claims and appeals following these specific payer requirements.
- Documents billing activities on the patient account to assist in problem resolution within Athena and/or other EMR system.
- Identifies compliance risk and proactively recognize and rectify any issues to prevent payer audits.
- Uses in depth knowledge of contracts and reimbursement to obtain the proper resolution.
- Monitors assigned work to ensure billing and follow-up activities are maintained at the levels set by management.
- Establishes independent follow up processes on accounts worked to ensure payer response.
- Monitors and identifies claim rejections or denials for trends for the assigned payer and reports them to management.
- Upon receipt reviews and determines the proper disposition of claims with credit balances.
- Responsible for the daily reconciliation of charges, adjustments, and payments.
- Post Medicare, Medicaid, Blue Cross/Blue Shield, and other third-party payments. Maintain files. Pulls copies of paid/processed claims for the file. Follow-up unpaid claims within 45 days.
- Post commercial checks and denials to individual client accounts.
- Pull copies of paid/unpaid claims from files. Resubmit bills and/or follow-up with insurance company (or Client) when necessary. Post managed care additions and deletions.
- Ensure payments posted in the system balance against amounts received/deposited.
- Interact with clients in a positive and professional manner; sensitive in approach to discussions with clients regarding financial matters.
- Generate patient statements and process Worker’s Compensation claims.
- Responsible for the collection of bad debt.
- Other responsibilities as assigned by supervisor.

**Benefits**:
Medical, Dental, Vision, 403B with Company Match, Paid Time Off, Life Insurance, Continuing Education Opportunities and more

At Amoskeag Health, Diversity & Inclusion are embedded in our Mission. We are an Equal Opportunity Employer (EOE), and our employees are people with different strengths, experiences and backgrounds, who share a passion for helping people lead healt

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