Billing Specialist I

Billing Specialist

The Carmelite System is a multi-state, not-for-profit senior living organization sponsored by the Carmelite Sisters for the Aged & Infirm operating a network of Skilled Nursing Facilities and Assisted Living/Independent Living communities.

We are seeking to hire a Billing Specialist I.

• This corporate level position is fully remote. Current Team members work in Eastern and Central Standard Time.
• Billing Specialist I = $30K to $55K annually based on skills, experience and cost-of-living data.

Billing Specialist I Qualifications:

• High School diploma or equivalent.
• Extensive knowledge of Medicare, Medicaid, managed care networks and insurance carriers required.
• Extensive knowledge of accounts receivable functions including CPT and ICD-10 coding required.
• Solid understanding of the current Medicare Compliance, OSHA, and HIPAA regulations and medical terminology required.
• Strong basic mathematical skills required.
• Understanding of Medicaid, Medicare, and Third Party Billing preferred.
• Billing Specialist II = 2+ years experience of skilled nursing facility billing and 2+ years experience using PCC (Point Click Care).

Billing Specialist I Job Summary:

• Prepare, review, and transmit claims using billing software.
• Analyze explanation of benefits forms to review denial codes and make appropriate corrections.
• Follow up on balances, unpaid claims, appeals & denials within the set timeframe.
• Post payments and adjustments to accounts and maintain backup records.
• Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Ensure proper records handling.
• Input ancillary charges into the billing software in accordance with protocol.
• File all charge, payment, adjustment batches, refund requests and write off requests in the appropriate format and location (PCC and shared drive).
• Prepare and review claims for billing prior to triple check.
• Attend and lead monthly triple check reviews.
• Follow claims process from submission to clearinghouse and ensure acceptance at payer.
• Process refunds to insurance companies in accordance with policy.
• Monitor reimbursement from managed care networks and insurance carriers.

This is a brief overview of job responsibilities and not intended to be all inclusive.

We aim to create a supportive workplace where you are valued, compensated fairly and provided the tools to thrive

The Carmelite System Can Offer You:

• Competitive Compensation
• Health (Aetna), Dental, Vision, HSA with employer contribution
• Student Loan Forgiveness Guidance
• Flexible Spending Account
• Fully paid Life and Long-Term Disability insurance
• Benefits available 1st of the mo. following 30 days
• Supplemental insurances
• Retirement Plan
• Employee Assistance Program with Discount Marketplace
• Generous Paid-Time-Off with 11 Holidays

Please consider joining our team working where The Difference is Love℠

The Carmelite System, Inc. is an Equal Opportunity Employer and adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, and any other legally protected class.

Required

• 1 year(s): Solid understanding of the current Medicare Compliance, OSHA, and HIPAA regulations and medical terminology required.
• 1 year(s): Extensive knowledge of accounts receivable functions including CPT and ICD-10 coding required.
• 1 year(s): Extensive knowledge of Medicare, Medicaid, managed care networks and insurance carriers required.

Required

• High School or better

Preferred

• Customer Service

Preferred

• Team Player: Works well as a member of a group
• Functional Expert: Considered a thought leader on a subject
• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Preferred

• Self-Starter: Inspired to perform without outside help
• Job Security: Inspired to perform well by the knowledge that your job is safe
• Goal Completion: Inspired to perform well by the completion of tasks
• Entrepreneurial Spirit: Inspired to perform well by an ability to drive new ventures within the business
• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.