Rev Cycle SBU Billing Spec- Must have experience with Medicaid authorization and Excel data entry/spreadsheet

Overview

The Revenue Cycle Account Billing Specialist manages the accounts receivable in accordance with compliance regulatory and billing guidelines and specific payer rules. Responsible for the accurate billing of insurance claims by validating coverage and resolving charge review edits, claim edits and front end clearinghouse and payer rejections. Responsible for verifying accuracy of all billing requirements that are obtained in order to confirm work orders, obtain prior authorizations, process and post self-pay payments, submit claims and identify and resolve billing errors. Responsible for creating and uploading statement files, as well as working any incorrect address rejections. In addition, prepares accounts for bad debt. Accountable for Carle Financial Assistance Program (CFAP) set up and review of account and adjustment requests. Other duties include follow up on outstanding receivables through activities such as basic appeals, answering, documenting and completing inquiries from patients, insurance companies, public agencies, internal departments and 3rd party payers.

Responsibilities

Identifies and resolves insurance set up errors to facilitate accurate and timely billing and payment processing. Resolves charge review edits, claim edits and clearinghouse and payer rejections to facilitate accurate billing and payment processing. Submits claims for assigned payers, including corrected and voided claims. Works accounts receivable work queues or task lists to perform collection activities such as following up on outstanding receivables; contacting patients, payers, attorneys or employers via phone, website/web portal or mail. Reviews and resolves incoming correspondence for outstanding accounts receivable. Resolves underpayments, no payments, overpayments and undistributed payments for proper allocation. Identifies, prepares and requests adjustments. Identifies bad debt accounts and prepares information for the collection agency as necessary. Answers phones to complete inquiries from patients, attorneys, insurance companies, public agencies, internal departments and 3rd party payers. Prepares, completes and follows up on designated payer reports and forms. Establishes payment arrangements and applies self-pay payments. Reviews, processes and requests prior and subsequent authorizations based on payer guidelines on an as needed basis. Reviews, processes and confirms all work orders to ensure accuracy. Creates, uploads and processes files for self-pay statements and payment arrangements. Responsible for Community Care Financial Assistance Program set up, review of accounts and adjustment requests. Responsible for Prompt Pay Discount review and adjustment requests.

Qualifications

Certifications: , Education: Associate's Degree, Work Experience:

Carle Health Company Overview

Find it here.

Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.

 

Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

 

 

 

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Salary Range

The compensation range for this position is $16.59per hour - $26.88per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.