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Billing Specialist

3 months ago

Des Moines, United States Calvin Community Full time
Billing Specialist

Calvin Community is nestled in the heart of Des Moines’s Beaverdale neighborhood. Calvin Community is a not-for-profit senior living community focused on serving older adults in a caring, Christian Community designed to meet their physical, social, spiritual, and psychological needs and contribute to their health, security, and happiness. Calvin Community proudly provides high-quality, compassionate services in independent living, assisted living, skilled nursing, long-term care, and memory support care for residents.

The successful candidate for this position must have knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements in a long-term care setting. The candidate must have excellent written and oral communication skills.

Key Accountabilities of the Medicare Billing Specialist include:
  • Entering insurance and co-insurance and responsible party information into the billing system and preparing and transmitting claims 
  • Review daily census information
  • Review, enter, and process private pay statements including ancillary charges, Medicaid, and Medicare claims.
  • Review and follow up on all outstanding statements and claims, including private pay, Medicare, Medicaid, and co-insurances.
  • Assisting with financial information related to long-term care insurance and/or processing long-term care insurance when appropriate.
  • Responsible for inquiries from the long-term care insurance companies.
  • Assisting with Medicaid and Elderly Waiver applications as needed.
  • Review resident statements and correct any missing or inaccurate information
  • Use of insurance carrier portals for eligibility and claims information; verifying coverage and eligibility for services provided, working with insurance companies to secure any pre-authorizations required for procedures, and/or working with counseling staff to secure or track any pre-authorizations for procedures
  • Collects delinquent accounts by establishing payment arrangements with patients; monitoring payments; and following up with patients when payment lapses occur.
  • Entering and balancing cash receipts.

Requirements and Qualifications:
  • Experience with long-term care and healthcare billing.
  • Familiarity with CPT, ICD-10, and HCPCS Coding.
  • Exceptional Customer Service skills for interacting with patients regarding medical claims and payments, including communication with patients and family members.
  • Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections.
  • Knowledge of medical terminology is likely to be encountered in medical claims.
  • Effective communication abilities for phone contacts with insurance payers to resolve issues.
  • Good analytical and problem-solving skills.

Job Type: Full-time
Benefits:
  • 403(b) 
  • Voluntary Benefits (Health, Dental, Vision, and Life)
  • Employee assistance program
  • Flexible spending account
  • Paid time off
  • Tuition reimbursement
  • Discounted staff meals


About Calvin Community:

Since 1965, Calvin Community’s success can be attributed to its mission: to provide, on a non-profit basis, services to older adults in a caring, Christian community designed to meet their physical, social spiritual and psychological needs and contribute to their health, security and happiness.