Enrollment/Billing Representative

Job Summary:

• The Collections Specialist is responsible for managing third-party billing and collections, ensuring timely and accurate payment of claims, and processing payer appeals.
• This role involves investigating denials, processing rejections, and identifying root causes of payment issues, with the goal of resolving discrepancies and maximizing reimbursement.
• The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills.
• The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365.

Essential Duties & Responsibilities:

• Understand Third Party Billing and Collection Guidelines.
• Identify root cause of issues and demonstrate recommendations for corrective action steps to eliminate future occurrences of denials.
• Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
• Contact payer, or patient as appropriate.
• Documents all collections activity in patient collections notes.
• Documents work performed/action taken on AR Reports.
• Process all Payer appeal requests within the time frame required by the Payer.
• Reviews claim processing to determine proper payment has been issued.
• Request and process all approved adjustments.
• Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer.
• Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid, and whether additional approval is required.
• Ability to identify errors, correct claims and reprocess for reimbursement.
• Ability to read and interpret an EOB for accurate understanding of claim processing.
• Knowledge of claims investigation and reviewing payer contracts for reimbursement.
• Performs other duties as assigned.

Education:

• High school graduate or equivalent.
• Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.
• Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.
• This position includes fiduciary duty or access to financial systems: Yes.

3 Non-Negotiable Skills:

• Insurance Collection Exp (1+ years).
• Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams and Excel (Basic skills).
• Denial Management Resolution (1+ years).

Knowledge, Skills & Abilities:

• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.
• Helpful, knowledgeable, and polite while maintaining a positive attitude.
• Interpret a variety of instructions in a variety of communication mediums.
• Knowledge of Home Infusion.
• Knowledge of insurance policies, reimbursement practices, as well as claim processing requirements.
• Knowledge of medical billing practices and of medical billing reimbursement.
• Maintain confidentiality and practice discretion and caution when handling sensitive information.
• Multi-task along with attention to detail.
• Ability to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division.
• Self-motivation, organized, time-management and deductive problem-solving skills.
• Work independently and as part of a team.
• Collections or medical billing experience with basic understanding of ICD10, CPT4, HCPCS, and medical terminology is preferred.
• Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
• Medicare knowledge of billing requirements specific to DMEMAC.
• HCN360 and CPR+ knowledge preferred.
• Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams and Excel.
• Strong customer service skills.