HMO Billings and Collections Specialist

5 days ago

Vancouver, Washington, United States Prestige Care Full time

HMO Billings and Collections Specialist

Prestige Care

Vancouver, WA

Wage range: $25 - $34 per hour
Status: Non-Exempt
Location: Remote
Schedule: Monday - Friday

What does the HMOBilling and Collections Specialist do?

In this role you will be responsible for recording allrevenue, electronic claim submissions, and timely collection from all HMO payersources. If you have a keen eye for detail, ensure timely follow up, and loveto "check things off," this role is for you

In This Job, Every DayYou Will:

Monitors HMO claims by reviewing and clearingHMO dashboard daily, verifying eligibly, reviewing case management software,and ensuring payer and claim form is set up in patient records. Ensures all billing and collections are pursuedin a timely and effective manner for assigned centers, including researching,adjustments and rebills as needed. Identifies reconsiderations, appealopportunities, and collaborates and coordinates with facility staff to fulfillaudit requests. Completes HMO Triple Check with assigned centersto ensure UB-04 claim forms are correct and all revenue is accounted for andbooked correctly. Ensures HMO billing is submitted by the 5th day and verifies receipt of claims by the 7thbusinessday. Follows Prestige collections policy for all HMOpayers and reports in a timely manner. Documents all collection efforts in thepatient billing record and healthcare software. Reviews business intelligence software data andrevenue cards and posts all revenue in company's healthcare software. Ensures revenue is properly booked and billed byutilizing exclusion worksheets. Research denials and over/under payments for allHMO claims. Submits and processes all revenue adjustments and savesdocumentation according to company policy. Maintains in-depth knowledge of all HMOcontracts and contract changes. Provides education and communication to teammembers regarding HMO contracts. Maintains constant communication with thecenters Administrator, Business Office Manager (BOM), Admission Director, andRegional Manager of Field Accounting (RMFA). Performs other duties as assigned.

Education & ExperienceYou Need to Qualify:

Associates degree in business, accounting orfinance or equivalent knowledge and skills obtained through a combination ofeducation, training, and experience. Minimum of 2 years' experience in a healthcareor accounting environment with an emphasis on HMO contracts, billing, andcollections. Knowledge of HMO contracts and Medicare/Medicaidregulations preferred. Ability to creatively problem-solve, be a teamplayer, be well organized and flexible. Experience in the development and training inaccounting procedures and rules, and multi-site coverage an asset. Must be proficient with Microsoft Excel,accounting software, and experience with EHR and billing systems/software.

Ways you can advancebeyond the Senior Maintenance role:

Once you master this role, you could consider the RegionalManager of Field Accounting or the Director of Field Accounting positions.

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