BetterHealth A Planned Parenthood Partnership
Department: revenue cycle management
Accountable to: director or associate director, revenue cycle
The reimbursement specialist supports one or multiple affiliates’ revenue cycle activities by performing all billing and collection functions for selected payer groups/financial classes, including posting and follow up on all outstanding accounts receivables (a/r)Provide feedback as appropriate to improve affiliate performance and increase reimbursementComplete billing special projects as assigned.
Essential duties and responsibilities:
Conduct appropriate claim follow-up on all open a/r to ensure prompt adjudication, maximize revenue and maintain the practices’ key performance indicators.
Perform daily era, eob, rx and patient payment posting.
Review and monitor clearinghouse claim errors and global payer rejections for possible system edits or payer updates.
Analyze payer denial trends, strategize and test various billing methodologies and payer coding requirements to ensure payment of all claims due to the practice.
Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed prior to contractual deadlines.
Run all reports needed to successfully manage the claims business for specified payers/financial classes.
Ensure the practice’s claim kpis are satisfied within specified payer group(s).
Participate in revenue cycle team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes.
Serve as an active agent on the betterhealth billing line.
Attend internal and external other assigned training and meetings to improve knowledge base and claim efficiency.
Complete special projects as needed.
Oversee and improve billing and collection strategies and systems in assigned payer category.
Submit daily electronic and paper claim files, and correct all nextgen claim edit rejections; run statement files; and download eras/eobs as needed
Other responsibilities as assigned.
Skills and requirements/qualifications:
Bachelor’s degree preferred, high school diploma or equivalent required
Three to five years’ experience in medical billing and/or accounts receivable
Experience with patient billing and collections
Ability to handle confidential materials that relate to a variety of individuals
Ability to thrive in a fast-paced environment superb attention to detail
Strong problem solving skills
Ability to work independently, including handling multiple projects/tasks simultaneously
Access to secure, reliable internet and utilities; access to send outgoing mail
Ability to support hours of operation in the pacific time zone