What are the responsibilities and job description for the CM-MANAGED CARE BILLER position at Cadia Healthcare - Hyattsville?
Benefits
- Personal, Vacation, Sick Days & Paid Holidays
- Health, Dental, and Vision insurance; Company Paid Life insurance
- A 401(k) plan with company match.
- Maternity Leave Options, Short and Long Term Disability.
- Personal and Family Medical Leave.
Employee Perks Program
- Tickets At Work/Ticket Monster – Discount Programs
- Free and Discounted Employee Meals
- Tuition Reimbursement
- In Facility Training/Inservice Programs
- Employee Assistance Program
- Free Will/Estate Preparation Services
- Free/Discounted Legal Services Program
- Obtaining referrals and pre-authorizations as required for procedures.
- Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
- Reviewing patient bills for accuracy and completeness and obtaining any missing information.
- Continual follow-up on outstanding accounts through contracts/inquiries to third-party and governmental payers to facilitate prompt resolution or payment based on the Follow-Up department guidelines.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Checking each insurance payment for accuracy and compliance with contract discount.
- Calling insurance companies regarding any discrepancy in payments if necessary. Request refunds or retractions as appropriate.
- Identifying and billing secondary or tertiary insurances.
- Analyze and calculate the payment and contractual amounts on remittances received from payers. Includes denied claims to ensure that patients are billed appropriately.
- Reviewing accounts for insurance of patient follow-up.
- Researching and appealing denied claims.
- Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
- Setting up patient payment plans and work collection accounts.
- Updating billing software with rate changes.
- Updating cash spreadsheets and running collection reports.
In addition to these general duties, an individual employer may request that you perform other duties that fit with your training and background experience or provide further training for new duties.
- Minimum of 1 year Managed care billing
- Good understanding of reimbursement methodologies and terms.
- Understands commercial & government payer billing requirements.
- Strong knowledge of industry trends in Managed Care.
- Familiarity working with third-party contracts and payment rules.
- Demonstrates an expertise in insurance, managed care and federal/state coverage.
- Work requires a high level of problem-solving skills.
- Ability to ensure the confidentiality and rights of patients and the rights of patients and the confidentiality of nursing home and departmental documents.
- Demonstrates a working knowledge of personal computers and other standard office equipment.
- Demonstrates a positive demeanor, good verbal and written communication skills and be professional in both appearance and approach.
- Ability to handle potentially stressful situations and multiple tasks simultaneously.
- Ability to successfully complete additional job-related training when offered.
