Home Health Billing Specialist

JOB PURPOSE:

Supports the delivery of all Insurance billing services by final/higher level auditing, correcting, and submitting claims. Ensures that billing services are timely, accurate, and allow for appropriate reimbursement. Conducts all claims-related follow up on payment delays, taking corrective action(s) to finalize account disposition and/or referring claims to the appropriate staff to ensure appropriate reimbursement in the timeliest manner possible. Conducts month-end close and cash posting responsibilities for all assigned locations. This position functions within a team environment and under general supervision.

Successful individuals manage a volume of work as established by Right at Home productivity performance standards, are familiar with the rules and regulations of Insurance billing and are skilled at problem solving and account resolution. They work well within a team and help foster an environment where continuous improvement in business processes and services is welcomed and recognized to build a high-performance culture via the standard Right at Home responsibilities.

KEY RESPONSIBILITIES:

1. Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims, with the objective of receiving appropriate reimbursement based upon services delivered and ensuring that the claim is paid/settled in the timeliest manner possible.

2. Works with assigned community services facilities' administrators and office personnel to manage relevant accounts receivable.

3. Edits claim forms, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct diagnosis, and procedure codes are utilized.

4. Submits Insurance claims, including the maintenance of bill holds and the correction of errors, to provide timely, accurate billing services.

5. Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions.

6. Conducts account follow up including the investigation of payment delays to appropriately maximize reimbursement based upon services delivered and ensuring claims are paid and settled in the timeliest manner.

7. Applies knowledge of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to research payment variances, make corrections, and take appropriate corrective actions to ensure timely claim resolutions.

8. Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect.

9. Responds to inquiries, complaints or issues regarding patient billing and collections, either directly or by referring the problem to an appropriate resource for resolution.

10. Participates in cross-training and job enlargement opportunities for major job. responsibilities. Works with direct supervisor to identify minor set of responsibilities to develop and perform.

11. Plans, organizes, and documents work to deliver business results by meeting or exceeding all individual operating metrics and service line agreement objectives.

12. Contributes ideas and actions towards the continuous improvement of Revenue Cycle processes.

13. Adapts to learning new processes, concepts, and skills; Seeks and responds to regular performance feedback from team lead and provides upward feedback, as needed.

14. Assists in orientation and appropriate training of team members, including helping cross-train peers in minor responsibilities and acting as a mentor to peers.

15. Maintains positive work relationships with members of own and other teams to communicate effectively and ensure compliance with cross-team responsibilities.

16.  Assist with Accounting (billing and payroll) responsibilities. 

KNOWLEDGE, SKILLS, ABILITIES:
• In-depth knowledge of various billing documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of patient accounts.
• Knowledge of insurance and governmental programs, regulations and billing processes, commercial third-party payers, and/or managed care contracts and coordination of benefits
• Familiarity with medical terminology and the medical record coding process
• Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections
• Familiarity with Insurance Claims management functions in non-acute settings
• Knowledge of Patient Management information system applications

MINIMUM EDUCATION REQUIRED: AA/AS in Accounting or Business (or Equivalent Education / Experience) preferred.

MINIMUM EXPERIENCE REQUIRED:

• Demonstrates experience and a proven track record in Insurance Claims in a medical setting of moderate size and complexity, information systems, and patient accounting applications, as typically acquired in1-3 years of patient accounting / medical billing positions

• Experience in month end close activities and reconciling cash received to the patient accounting system

Right at Home's mission is improve the quality of life for those we serve. We accomplish this by providing the Right Care, and we deliver this brand promise each and every day around the world. However, we couldn't do it without having the Right People. Our care teams are passionate about serving our clients and are committed to providing the personal care and attention of a friend, whenever and wherever it is needed.

That's where you come in. At Right at Home, we help ordinary people who have a passion to serve others become extraordinary care team members. We seek to find people who are compassionate, empathetic, reliable, determined and are focused on improving the quality of life for others.

To our care team members, we commit to deliver the following experiences when you partner with Right at Home:

• We promise to help you become the best you can be. We will equip you as a professional by providing best in class training and investing in your professional development.
• We promise to coach you to success. We're always available to support you and offer you tips to be the best at delivering care to clients.
• We promise to keep the lines of communication open. We will listen to your ideas and suggestions as you are critical to our success in providing the best possible care to clients. We will provide you timely information and feedback about the care you provide to clients.
• We promise to celebrate your success. We will appreciate the work you do, recognize above and beyond efforts, and reward you with competitive pay.

This franchise is independently owned and operated by a franchisee. Your application will go directly to the franchisee, and all hiring decisions will be made by the management of this franchisee. All inquiries about employment at this franchisee should be made directly to the franchise location, and not to Right at Home Franchising Corporate.