Insurance Billing Specialist III

4 weeks ago

Milwaukee, United States North Shore Healthcare Full time

Trust, engagement, competence, respect and passion these are the values under which North Shore Healthcare operates every day. Our dedicated team of professionals strive to deliver quality care to our residents and their families. We are one of the leading employers and providers of post-acute care in the Midwest and we are seeking exceptional individuals to join our team. If you value being a leader, working in a progressive environment and having opportunities to grow in your career, North Shore Healthcare is the Right Choice for you.

Summary/Objective:

Performs all duties related to the timely and efficient billing and collection of private insurance receivables for a group of facilities in a central billing environment, within the parameters established by company policies and third-party billing requirements, and as necessary to achieve reasonable collection goals.

Essential Job Functions:

  • Prepares and submits all Managed Care Insurance billing, turnaround documents and claim adjustments.
  • Communicates closely with facility Business Office Manager to ascertain or correct payer type errors related to insurance billing types.
  • Utilizes company approved system to document and follow up on payer commitments
  • Identifies payment discrepancies and unpaid claims; takes appropriate action to resolve balance.
  • Prepares A/R adjustments and corrections as needed.
  • Identifies, researches and resolves credit balances according to policy and payer requirements.
  • Identifies adverse facility trends resulting in returned or denied claims (e.g., repeated failure to obtain prior authorization) and communicates to Business Office Manager for follow-up.
  • Reports status of claims and AR balances to supervisor, upon demand and/or according to established schedule and procedures.
  • Participates in monthly AR review.
  • Prepares account write-off when collection efforts exhaust and submits to supervisor.
  • Assists with training and orientation of Insurance Billing Specialist I/II.
  • Other duties as assigned.
  • Adheres to the Company Code of Conduct and Business Ethics policy, including documentation and reporting responsibilities.

Qualifications:

High school diploma or G.E.D.

Minimum of three (5) years experience in health care insurance billing, preferably for skilled nursing facility providers.

Comprehensive knowledge of Medicaid programs, including eligibility criteria, covered services, billing rules, recipient rights and provider responsibilities

Exposure to automated tasking system preferred.

Ability to manage, analyze and reconcile billing and payment detail.

Ability to work well in a team-oriented, cooperative environment.

Strong organizational skills and communication skills.

Basic understanding of Excel and Word, mainframe computer systems and PC LANs.

Ability to maintain regular attendance.

Capable of performing the essential duties of this job, with or without reasonable accommodation.

Benefits:

We offer a comprehensive benefit packages which includes:

  • Health insurance for full-time employees starting the first of the month following 30 days of employment
  • Dental and vision insurance for full and part-time staff
  • 401(K) Program for full and part-time staff
  • 6 paid holidays plus one floating holiday for full-time staff
  • Company paid life insurance for full-time staff
  • Voluntary life and disability insurance for full-time staff
  • Paid Time Off
Our mission is to establish a culture that reinforces the values necessary to be the premier health services provider and employer in each of the communities we serve. We understand that choosing where you want to go in your career is a big decision. We would like the opportunity to show you that North Shore Healthcare is the Right Choice for you.

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