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Billing Specialist

3 months ago

South Portland, United States Northern Light Health Full time
Northern Light Home Care and Hospice

Department: Patient Financial Services

Position is located: The position is office based and can be from any one of our current Home Care Locations.

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Summary:

The Billing Specialist is responsible for coordination of and participation in the billing and reimbursement process of the organization. Responsibilities include accurate claims submission to all payers and submission of claims in accordance with regulatory and contractual obligations including all activities related to benefit verification and resolution. The incumbent is responsible for all aspects of the billing claim cycle including prior authorizations requirements, patient eligibility, claim appeals processing, payment posting and denial resolutions. The Billing Specialist is responsible for monitoring accounts receivable and managing accounts within agency established policies. This position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality.

Responsibilities:

  • Performs benefit verification and resolution as needed.
  • Processes accurate claim submission, daily or as needed.
  • Accurately applies payments and reconciles with cash logs, daily and month end.
  • Processes denied claims, follows appropriate appeal process, and escalates as needed per payer guidelines.
  • Investigates and resolves credits for appropriate refunds or adjustments.
  • Identifies claim errors, trending issues and escalates to supervisor.
  • Collaborates with other teams to resolve claims, prior authorizations or benefit related issues.
  • Identifies and reviews claims holding in late EMC, escalating as needed to supervisor.
  • Participates in active AR recovery and review.
  • Maintains high level of knowledge pertaining to billing, reimbursement, and prior authorization regulations, attending trainings and ongoing education as needed.
  • Other duties as assigned.
Other Information:
  • Two years of related experience, one of which is in customer accounts and billing.
  • Knowledge of requirements of the Centers for Medicare & Medicaid Services (CMS) claims forms; CMS-1500 and CMS-1450 (UB04).
  • Knowledge of requirements of the Government and Non- Government payment policies and payer contracts.
Competencies and Skills
  • 2+ years of relative work experience required.* Relevant and one of which is in customer accounts and billing.
  • Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
  • Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
  • Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
  • Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
  • Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
  • Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
  • Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
  • Human Capital, Supply Chain and Financial Software.
  • Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
  • Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
  • MS Teams
  • Multi-line Phone
  • Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
  • Zoom
Education
  • Required Associate's Degree* In lieu of education, two years of experience is required per year of required education, exclusive of the minimum experience identified.
Required Experience
  • 2 year/years of Relevant Work Experience
Working Conditions
  • Work with computers, typing, reading or writing.
  • Lifting, moving and loading less than 20 pounds.
  • Prolonged periods of sitting.