Billing Specialist - Accounts Receivable & Appeals

Description

Essential Duties and Responsibilities

• Ensure timely and accurate billing of claims via electronic or paper to Medicare, Medicaid, and Commercial Insurances in accordance with policy using primarily Niko Health claim submission software and Salesforce.
• Work with all payers to ensure medical claims are being processed timely and paid accurately.
• Analyze and post EOB payments and denials in all billing systems, ensuring correct processing and payment. Determine root cause and prevention of future rejections & denials, advising management and appeals team where necessary.
• Route claims and/or balances that are deemed uncollectible to Financial Patient Responsibility Review or Write Off Queues timely and appropriately.
• Assist and communicate effectively with our patients, doctors, customers, and coworkers with billing inquiries at the highest-level support possible.
• Able to Identify process improvement opportunities and recommend potential solutions to improve departmental workflow.
• Assist with any other duties or projects on an as needed basis.
• Maintain regular and punctual attendance.
• Comply with all company policies and procedures, HIPAA and all state and federal regulations.
• Must meet or exceed production & quality KPI standards.
  
  

Minimum Qualifications

Education, Experience and Training

• Able to operate at a task and project level.
• High School diploma or equivalent, required.
• Some College and/or medical billing certificate, preferred.
• 2 years of Medicare, Medicaid and/or Commercial Insurance experience, particularly in HME, highly preferred.
• Intermediate knowledge/proficiency in Microsoft Office products and Salesforce, highly preferred.
• A combination of training, education and experience that is equivalent to the qualifications listed above and that provides the required knowledge, skills, and abilities, required.
  
  

Knowledge, Skills And Abilities

• A comprehensive understanding of Medicare, Medicaid, and/or Commercial Insurance program rules as it pertains to DME billing.
• Ability to take direction and communicate effectively with customers and employees at all levels of the organization.
• Ability to thrive in a fast-paced and dynamically changing organization.
• Must have strong work ethic.
• Excellent oral and written communication skills required.
• Strong attention to detail
• Ability to prioritize and manage daily responsibilities effectively
• Solutions-oriented problem solver
• Excellent planning, communication and organizational skills.
  
  

Physical Functions and Work Environment

The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.

Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.