Managed Care Billing Specialist
4 days ago
We are seeking a highly skilled Managed Care Billing Specialist to join our team at The New Jewish Home. As a key member of our Finance Department, you will play a critical role in resolving managed care denied and underpaid claims in a timely manner.
Key Responsibilities:- Resolve managed care denied and underpaid claims by understanding managed care contracts, creating project spreadsheets for submission to payers, writing reconsideration appeals, and communicating with MCOs.
- Collaborate with all MCO payers to resolve payment errors and underpayments.
- Submit monthly Excel reports and written appeals letters to resolve external underpayments in a timely fashion.
- Track MCO responses and maintain accurate records.
- Utilize billing system expertise (Netsmart/MyUnity) to identify payment discrepancies, monitor and track performance of recoveries, meet goals, audit claim payments, and identify other issues affecting AR.
- Work closely with the Revenue Cycle Director to resolve issues and ensure seamless operations.
- Minimum 5 years' experience in health insurance, skilled nursing home billing is required.
- Must have a strong understanding of Medicare, Managed Care, Medicaid (NY) billing and reimbursement.
- Prior experience working with managed care claims and appeals processes for skilled nursing home is required.
- Fluency in working with billing systems and strong Excel skills are essential.
- Understanding of EOBs, remittance advice, and managed care contracts is necessary.
- Strong communication skills, ability to de-escalate conversations, and work independently with minimal supervision are required.
- Ability to meet deadlines, troubleshoot, and present findings is essential.
- Detail-oriented with strong critical thinking and organization skills is necessary.
- Bachelor's Degree in a related field is required.
- Work requires an extensive knowledge of business and an excellent command of the English language, both written and verbal.
- Must have knowledge of office administrative procedures and familiarity with standard office equipment.
- Must have knowledge of computer software applications, including Word, PowerPoint, Excel, and other programs as needed.
- High level of interpersonal skills to handle sensitive and confidential situations is required.
- Some analytical ability is required to gather and summarize data for reports, find solutions to administrative problems, and prioritize work.
- Continual attention to detail is necessary in composing, typing, and proofing materials, establishing priorities, and meeting deadlines.
- Bachelor's Degree required for new hires.
- 3 – 5 Years related experience.
- Keyboard skill – 50 – 55 WPM.
- Board minutes writing experience.
Able to sit for long periods of time at the computer. Walking, sitting, standing or lifting while in the office environment limited to files and records not expected to exceed ten (10) pounds in weight.
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