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Specialist Medical Billing

Company: ICONMA, LLC
Location: Gainesville
Posted on: May 16, 2022

Job Description:

Job Description - Assures that all phases of processing client information are in compliance with HIPAA, PHI regulatory and related policies and practices; reports any Compliance issues to the Director of Operations. - Coordinates the insurance verification process and makes sure that the client understands their co-pay responsibility. - Responsible to follow-up as necessary to facilitate the collection of co-pays. - When applicable may gather credit card or other payment processing information from client and enters into system to process payment for account. - Manages the entry of client information into computer system in a timely manner and contact of referral source, customer and/or client to obtain missing information needed to set up client for service. - Ensures that the data is accurate and complete. - Confirms all sales orders in the system and ensures that all required information (e.g. proof of delivery, signed prescription, signed acknowledgement form, etc.) is on file before submitting claim for payment. - Follows up on all missing sales orders and reconciles billing questions on a regular basis until payment status is complete. - Responsible for the timely submission of claims (electronic and paper as needed) to payers; Corrects and resubmits front-end and back-end rejected claims. - Ensures that all cash is posted to the correct account in a timely manner. - Responsible for the timely follow-up and collection of payments due to the organization. This is accomplished by generating invoices and/or following up with clients and/or payers. - Uses available resources to maintain current regulatory guidelines and reimbursement information to insure that the company is obtaining all appropriate information as required for billing and reimbursement. - Performs other duties/projects as assigned by management including - Customer Service Support - Processing, Resolving And Logging Customer Inquiries. Position Summary: - The Medical Billing Specialist is responsible for facilitating the daily management of billing, accounts receivable and overseeing the collection efforts for the Continuum business. - The position requires the development and standardization of procedures for new payers and for the collection of co-payments from clients. - In addition, this position provides analysis and reporting of collection metrics such as critical aging trends and works with clients to establish the need for financial assistance as necessary. Responsibilities: - Facilitates the timely and accurate electronic transmission of claims to third party payers. - In cases where electronic transmission is not available, assures that the paper claim is properly completed and submitted in a timely manner. - This includes but is not limited to verification of insurance, confirmation of sales orders, providing notification to clients/caregivers regarding coverage and payment responsibilities, posting the receipt of payment in the computer system, transmitting secondary claims and working payment denials. - Assures that all phases of processing client information are in compliance with HIPAA, PHI regulatory and related policies and practices; reports any Compliance issues to the Operations Manager. - Communicates in a professional and positive manner with all clients and referral sources. - Oversees the insurance verification process and ensures that any co-payments due are communicated to the client prior to the order being delivered or shipped. - When applicable may gather credit card or other payment processing information from the client and utilizes the computer system to process payment for third party payers and clients. - Manages the entry of client information into the ERP system (e.g. Brightree) in a timely manner and contact of referral source and/or client to obtain missing information needed to set up the client for service. Reviews the data to ensure that it is accurate and complete. - Confirms all sales orders in the system and ensures that proof of delivery is on file before submitting a claim for payment. - Follows up on all missing sales orders and reconciles payment information on a regular basis. - Corrects and resubmits front-end and back-end rejected claims. - Ensures that all cash is posted to the correct account in a timely manner. - Responsible for the timely follow-up and collection of payments due to the organization. This is accomplished by generating claims and/or following up with clients and/or payers. - Communicates and reports to management monthly on client co-payment analytics. - Develops and updates procedures as required for billing and collection processes. - Conducts testing as necessary related to billing/collections processes within the ERP (e.g. Brightree) system. - Conducts research and uses available resources to maintain current regulatory guidelines and reimbursement information to ensure that the company is obtaining all appropriate information as required for billing and reimbursement. - Works with internal and external auditors as necessary to assure financial compliance. - Performs other duties as needed. Minimum qualifications: - In lieu of Degree, incumbent may present four years of progressively responsible work experience with a hospital or other health-care provider in an intake, insurance verification or collections function. - Knowledge of Medicare and other regulatory practices in order to assess effectiveness of intake referral activities. Such knowledge may be derived from graduation from an accredited educational program or on-the-job training of no less than two years in a Hospital Billing, Durable Medical Equipment or other health-care setting. - Should be well-versed in regulatory guidelines and industry standards for Medicare and/or specific payer benefit providers. - Familiar with health-care collection guidelines and practices; able to meet month-end deadlines and productions goals. - Strong time management and problem solving skills required. - Possesses excellent interpersonal skills; ability to work independently. - Flexibility and the ability to work effectively within a multidisciplinary team. - Ability to communicate effectively (verbal and oral) with team members, clients, caregivers, clinicians and referral sources. - Well organized and able to perform multifaceted projects in conjunction with normal activities. - Ability to operate a computer and use the operational software used by the office. - Ability to work under stressful conditions. Additional qualifications: Billing/Coding Certification highly desired. Knowledge, skills, & abilities: - Excellent interpersonal skills to interact with internal and external customers. - Planning and organizational skills including ability to meet deadlines. - Able work independently and as part of a team environment. - Familiar with accepted /insurance verification/billing/collection practices in a health care reimbursement setting - Problem Resolution and follow-up skills. - PC skills including Excel, PowerPoint, Access, Outlook. - Ability to learn industry-specific software applications. - Customer service oriented; able to work with irate customers with professionalism. - Knowledge of Federal & State regulations relating to Durable Medical Equipment for all Jurisdictions including Medicare Reimbursement and LCD Guidelines; HIPAA Privacy and Security laws and Joint Commission Accreditation Standards. Equipment, tools and work aids: - Phone System, Personal Computer (Desktop or Laptop), Calculator, Printer, Facsimile Machine, Scanner and other office equipment as necessary or assigned. Working conditions and environmental hazards: - Air conditioned, sheltered work environment with little or no exposure to hazardous or toxic airborne materials. - May be sitting for long periods of time; may be required to perform tasks requiring repetitive hand movements. - No environmental hazards indicated for this classification Strength requirement: Sedentary work: - Seated for the better part of the day performing functions of an administrative or clerical nature; may require stooping, bending, reaching, pushing, pulling, shifting or carrying of objects of up to 20 lbs. on occasion. - May perform tasks of a repetitive nature; i.e. keyboarding, calculating, ET. Al. - Has a moderate degree of control within the work environment; can modify placement of portable equipment; lighting and furniture, with approval. Type of physical requirements: Acuity near - Clarity of vision at 20 inches or less with or without correction. Talking: - Expressing or exchanging ideas by means of the spoken work. - Talking is important for those activities in which workers must impart oral information to clients or to the public, and in those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. - Must be clear in discussing product and requirement for compliance with federal regulations to complete order. Hearing: - Perceiving the nature of sounds. - Hearing is important for those activities which require ability to receive detailed information through oral communications. - Incumbent should display patience with clients who may have language challenges or their own hearing issues. - Bi-lingual assistance is available, in most cases.As an equal opportunity employer, ICONMA prides itself on creating an employment environment that supports and encourages the abilities of all persons regardless of race, color, gender, age, sexual orientation, citizenship, or disability

Keywords: ICONMA, LLC, Gainesville , Specialist Medical Billing, Accounting, Auditing , Gainesville, Florida

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