Managed care biller

Job Details:

Job Location: Capitol Hill Healthcare Center Inc - Montgomery, AL

Position Type: Full Time

Education Level: High School

Salary Range: Undisclosed

Job Shift: First

Job Summary

The Managed Care Biller is responsible for managing the billing and accounts receivable process for residents covered by managed care plans within our Skilled Nursing Facility. This role involves working with managed care organizations, processing claims, and ensuring accurate and timely reimbursement.

Key Responsibilities

• Claims Processing: Submit accurate and timely claims to managed care organizations for services provided to residents. Verify that all necessary documentation and authorizations are in place before claim submission.
• Authorization Verification: Verify and obtain pre-authorizations for services covered by managed care plans. Communicate with managed care organizations to ensure authorization requirements are met.
• Payment Reconciliation: Reconcile payments received from managed care organizations with billed amounts. Investigate and resolve discrepancies in payments and denials.
• Accounts Receivable Management: Monitor and manage accounts receivable for residents covered by managed care plans. Follow up on overdue payments, denials, and underpayments.
• Billing Inquiries: Address billing inquiries and payment-related concerns from managed care organizations. Collaborate with the managed care organization's billing and claims departments as needed.
• Financial Reporting: Prepare and maintain accurate records of managed care billing and collections. Generate reports on accounts receivable and billing performance for managed care plans.
• Coordination with Other Departments: Collaborate with the admissions and finance teams to ensure accurate and timely billing for residents covered by managed care plans. Communicate relevant billing and authorization information to appropriate departments.
• Compliance: Ensure compliance with managed care contracts, billing regulations, and industry standards. Stay informed about changes in billing regulations and managed care policies.
• Documentation and Recordkeeping: Maintain organized and up-to-date records of all managed care billing transactions. Archive and store documentation according to retention policies.
• Customer Service: Provide excellent customer service to residents covered by managed care plans and liaise with managed care organizations. Address inquiries, concerns, and facilitate communication between the facility and managed care partners.

Qualifications:

Preferred Qualifications

• High school diploma or equivalent; additional education in Finance, Accounting, or a related field is a plus.
• Previous experience in billing, accounts receivable, or a related financial role, preferably in a healthcare setting with managed care billing.
• Knowledge of managed care billing processes, claims submission, and accounts receivable management.
• Strong attention to detail and accuracy in data entry.
• Effective communication and interpersonal skills.
• Proficiency in using billing software and Microsoft Excel.

Working Conditions

Works in office area(s) as well as throughout the nursing service area (i.e., drug rooms, nurses’ stations, resident rooms, etc.). Moves intermittently during working hours. Is subject to frequent interruptions. Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances. Is subject to hostile and emotionally upset residents, family members, personnel, and visitors. Communicate with the medical staff, nursing personnel, and other department directors. Works beyond normal working hours and on weekends and holidays when necessary. Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.). Is involved in community/civic health matters/projects as appropriate. Attends and participates in continuing educational programs. Is subject to injury from falls, burns from equipment, odors, etc., throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants. Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the AIDS, COVID-19, and Hepatitis B viruses. May be subject to the handling of and exposure to hazardous chemicals. Maintains a liaison with the residents, their families, support departments, etc., to adequately plan for the residents’ needs.

Education

Must possess and maintain any and all necessary active and unencumbered certifications, degrees, or licenses in the necessary state, to the extent the position requires such certifications, degrees, or licenses.

Specific Requirements

• Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served.
• Must be a supportive team member, contribute to and be an example of teamwork and team concept.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
• Must be able to relate information concerning a resident’s condition.
• Must not pose a direct threat to the health or safety of other individuals in the workplace.

Physical and Sensory Requirements (with or without reasonable accommodation)

(With or Without the Aid of Mechanical Devices) Must be able to move intermittently throughout the workday. Must be able to read, speak, and understandably write the English language. Must be able to cope with the mental and emotional stress of the position. Must function independently, and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies. Must meet the general health requirements set forth by the policies of this facility, which include a medical and physical examination if the position requires. Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility. Must be able to push, pull, move, and/or lift a minimum of 50 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet. May be necessary to assist in the evacuation of residents during emergencies.

All Other Duties as Assigned.

I understand this job description and its requirements; I understand that this is not an exclusive list of the job functions and that I am expected to complete all duties as assigned; I understand the job functions may be altered by management without notice and that I am an at-will employee.

Accommodations

The facility is an equal opportunity employer and recognizes that an individual with a disability may require accommodation to enable the individual to successfully perform a job function. I understand that I should discuss with my supervisor any needed accommodation. I agree to cooperate with the facility in identifying and discussing any available reasonable accommodation that may enable me to perform the essential function(s) of my position.