Insurance Billing Specialist

Compassionate Care is our Calling!

Why choose 3HC:

3HC has provided compassionate care to North Carolinians since 1981. We strive to ensure our patients enjoy life’s journey, recover quickly, and live comfortably. We believe in providing high-quality, cost-effective care that surpasses industry standards. If you want to make a difference, provide meaningful one-on-one care, and develop relationships with both your patients and team members, join Team 3HC! 3HC strives to provide a positive work culture that feels more like a family atmosphere where we support our team members so they can reach their personal & professional best.

• Associate's Degree in Business Administration, or related field preferred
• At least one-year experience in medical insurance or accounts receivable functions in home care preferred
• Computer knowledge required
• Ability to maintain confidentiality
• Minimum of 2 years of education or experience related to insurance verification/authorizations required, healthcare related preferred
• Excellent time management and prioritization skills
• Able to work independently and seek out resources to problem solve

• Abides by and supports 3HC's Compliance Program and Code of Ethics. 3HC's Compliance motto is "Compliance for all and all for Compliance". It is the intent of 3HC to comply with all applicable laws and regulations and that spirit is embedded in all aspects of our services and business practices. Our success hinges on doing things ethically and legally, to which, each and every employee plays a critical role.
• Creates positive experiences for internal and external customers that will meet their expectations. (External customers include our patients, families, referral sources, vendors, the community, etc. Internal customers are the people within the agency with whom you work.) Displays a high degree of courtesy, tact, and knowledge of services provided by the agency in all contact with staff, patients, and visitors.
• Responsible for the billing process and collection activity for assigned home health and/or hospice payors: (a) responsible for timely billing via Matrixcare/Inovalon, (b) analyzes all non-paid accounts beginning 30 days after billed by investigating problems, ensuring correct bill sequence was done, correcting errors, and making any adjustments/updates necessary, (c) documents and maintains timely follow-up (d) complete refunds as needed, and (e) minimize reserve for bad debts by maintaining current accounts receivable and ensure days sales outstanding (DSO) is at or below industry standard.
• Monitor and advise Manager when claim formats need revision.
• Responsible for assisting Manager with monthly and/or quarterly reports as needed.
• Serve as back-up for other Billing Collection Specialists and/or Payment Specialist as needed.
• Effectively communicates daily updates including problems, deadlines, new information, or other issues to Manager.
• Responds appropriately to patient/family request as well as other agency staff as related to patient's account.
• Review claim holds, claims errors, and validation holds daily.
• Work EVV errors for all Medicaid payers.
• Send out self pay statements and follow up for payment, send to collection agency if needed.
• Responsible for insurance process: (a) ensures insurance benefits are verified, preauthorization requirements are confirmed, and authorization is requested at the correct time points, per regulatory guidelines; (b) communicate clearly, professionally, and timely with patients. Notify patients verbally and in writing how their services are reimbursed per regulatory guidelines.
• Ensures; (a) all documentation is completed timely and accurately to include dates of the documentation entries; (b) library text should be utilized for payer plan notes and authorization note documentation should be up to date, clear and precise; (c) communicates timely with Intake and other departments regarding authorization and insurance coverage issues; (d) maintains expert knowledge of partnerships and assists the Intake team with completing the referral process to meet partnership expectation; (e) ensures batch errors related to Intake process are cleared on the same day of notification; (f) monitors for batch error trends and collaborates with the team to eliminate the batch error cause; (g) follow-up with patients as needed to assist in answering any benefit-related questions; (h) ensure follow up responsibilities are completed as assigned.
• Regulatory guidelines: (a) verification of benefits for services being rendered; (b) documentation of the benefits on the 3HC insurance form so that the admitting clinician may review the insurance form with the patient on admission; (c) mail a copy of the form to the patient by designated 3HC staff; (d) make every effort to notify patient or patient representative of out of pocket expenses prior to the start of care and document accordingly, to include unsuccessful attempts to reach patient.
• Maintains awareness of Insurance guidelines related to 3HC service lines and informs the intake team when made aware of new or changing guidelines.
• Maintains and updates a job specific procedure manual.
• Demonstrates an interest in personal and professional growth: (a) attends and participates in workshops, seminars, and webcasts to keep abreast of current changes in rules, regulations, relating to job functions; and (b) does individual reading and research.
• Demonstrates a willingness to be cost effective in the use of agency resources, the monitoring of waste, and the proper and safe use of supplies and equipment.
• Adheres to 3HC's Personnel Policy and performs other appropriate duties as assigned by supervisor to promote the successful operations and future growth of 3HC.

3HC is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex or sexual orientation, age, marital status, gender identity, national veteran or disability status.