Billing Specialist Enhanced Care Management

1 week ago


Covina, United States Heritage Group Homes, Inc. Full time

**Company Profile**: Heritage Group Homes, Inc. stands at the forefront of healthcare services, committed to enriching lives with cutting-edge care management solutions. Our focus is on crafting individualized care management programs that elevate patient outcomes and deliver compassionate support. We are on the lookout for a passionate individual to embrace the role of an Enhanced Care Management Enrollment Specialist within our dynamic team.

**Position Summary**:
The Billing Specialist, focusing on Enhanced Care Management, Commercial Insurance, and Utilization Review, is responsible for managing billing activities related to commercial insurance claims, utilization review processes, and enhanced care management services. This role ensures accurate claims submission, compliance with regulations, and effective communication with stakeholders.

**Key Responsibilities**:
**1. Billing for Commercial Insurances**:

- Prepare and submit claims for services covered by ECM plans.
- Prepare and submit claims for services covered by commercial insurance plans.
- Verify billing data accuracy and monitor claim processing for timely payment.
- Resolve billing discrepancies and denied claims through communication with insurance providers and clients.

**2. Utilization Review**:

- Conduct utilization reviews to assess the necessity and appropriateness of healthcare services.
- Review medical records and treatment plans to ensure compliance with insurance guidelines.
- Collaborate with providers and insurers to discuss review findings and recommendations.

**3. Enhanced Care Management Billing**:

- Manage billing for enhanced care management services provided by Heritage Group Homes, Inc.
- Ensure accurate and timely billing, compliance with regulations, and efficient communication with stakeholders.
- Set up vendor requirements and manage electronic funds transfers (EFT) as needed.

**4. Compliance and Documentation**:

- Maintain knowledge of billing regulations, insurance guidelines, and reimbursement procedures.
- Ensure compliance with regulations and accurately document billing activities and communications.

**5. Reporting and Analysis**:

- Generate and analyze reports related to billing, utilization review, and enhanced care management services.
- Identify trends and areas for improvement in billing processes and service delivery.

**6. Client and Provider Communication**:

- Serve as a liaison between Heritage Group Homes, Inc., clients, and insurance providers.
- Educate clients and staff on billing procedures and assist with billing inquiries.

**7. Vendor Requirements and EFT Management**:

- Set up and manage vendor requirements and EFT arrangements.
- Monitor EFT transactions to ensure accurate payments and resolve any related issues.

**8. Continuous Improvement**:

- Participate in training and suggest process improvements to enhance billing efficiency and accuracy.
- Collaborate with other departments to streamline processes and improve service delivery.

**Qualifications**:

- Education: High school diploma required; associate or bachelor’s degree preferred.
- Bilingual preferred
- Experience: Minimum of 3 years in medical billing with a focus on commercial
- insurance, utilization review, and enhanced care management services.
- Skills: Proficiency in billing software, attention to detail, strong analytical skills, excellent communication, and ability to work effectively in a fast-paced environment.
- Certifications: Certified Professional Biller (CPB) or Certified Coding Specialist (CCS) preferred; Certification in Utilization Review (URAC, ACMA, or equivalent) preferred.

Pay: $21.63 - $26.44 per hour

Expected hours: 40 per week

**Benefits**:

- 403(b)
- 403(b) matching
- Dental insurance
- Health insurance

Schedule:

- Monday to Friday

Work setting:

- In-person

Ability to Relocate:

- Covina, CA 91724: Relocate before starting work (preferred)

Work Location: In person



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