Billing and Reimbursement Specialist

Are you interested in joining a dynamic company that delivers successful in home treatment to clients with substance use disorder? If you are a caring, compassionate and capable Billing and Reimbursement Specialist who meets or exceeds the following, we want to hear from you!
 
Position Summary:
The role of the Billing & Reimbursement Specialist is to analyze the claim submissions and billing process to determine appropriateness and accuracy. The Billing & Reimbursement Specialist is responsible for handling claims processing including Accounts Receivable aging/collections and reviewing returned, disputed or rejected claims from commercial payers.
Position Highlights

• This role is hybrid out of Wallingford, CT
• Expectation is a minimum of 2 days in the office. *The initial 30 days may require additional in office time for training*
• This role is full-time non-exempt with a starting rate of $24-$28/hour

Benefits Highlights
Coverage: Health, vision and dental through Anthem Blue Cross Blue Shield, FSA, HSA that comes with an employer match, along with STD, LTD, life insurance, EAP, and more.
Balance: Competitive front loaded Paid Time Off (PTO) plan , 8 paid Holidays, 1 paid floating Holiday of your choice, and 1 day off for your birthday.
Development: Certification/continuing education eligibility, leadership development and 1 paid day off a year to go towards personal professional development.
Retirement: 401(k) retirement plan with 50% employer match up to 4%
Culture: Great Place to Work certified #GPTW, dedication to diversity, equity and inclusion, and a growing working environment.
*In order to be eligible for our full benefits package you must be employed full time at a minimum of 32 hours a week*

Aware Recovery Care is an Equal Opportunity Employer


ResponsibilitiesESSENTIAL FUNCTIONS:

• Ability to assess and track why payments are being billed incorrectly and appropriately create mitigation strategies to reduce additional risks.
• Work with external and internal staff to ensure on getting all claims paid in a timely manner.
• Obtain reimbursement from responsible parties by direct contact as needed to facilitate reimbursement.
• Manage a large number of accounts and claims.
• Ability to work 300 minutes on the phone/portal for claims adjudication.
• Manage claims via multiple platforms and systems.
• Ability to negotiate claims and resolve claims with external agencies.
• Ability to identify Verification of Benefits (VOB) issues as it pertains to claim resolution  and resolve the issue or report the issue.
• Ability to assist with cash posting, posting charges, and/or assist with daily, weekly and monthly closing, as needed.
• Run claims, and cash posting reports daily, weekly, monthly and quarterly as assigned.
• Identify and communicate with payer and/or system trends to Management regarding unpaid claims, denials, reimbursement issues, etc.
• Maintain thorough knowledge of payer contract, regulations and guidelines, as well as State and  Federal laws relating to reimbursement procedures to ensure accurate and compliant billing processes.
• Take initiative and action to respond and resolve customer Billing and Reimbursement inquiries  in a timely manner.
• Initiate payer disputes, initiate appeals and exhaust all internal collection efforts.
• Make recommendations for collection trends.
• Outbound phone calls to payers.
• Outbound phone calls to clients.
• Collect on accounts and troubleshoot all inquiries from the organization and  other entities based on insurance carrier information rules and regulations.
• Accountable for outstanding customer service that drives quality and an exceptional customer experience.
• Adapts to organizational change and departmental restructuring to fit the needs of our clients and payer sources.
• Perform miscellaneous job-related duties as assigned.

Required SkillsEducation:

• High School Graduate or GED equivalent

Experience:

• Minimum two years of previous healthcare Billing and Reimbursement
• Knowledge of CMS 1500, CPT codes and ICD-10
• Knowledge of 837 billing processes and 835 processes

Computer Skills:

• Proficient keyboarding and computer skills including word processing, spreadsheet, and Client Accounts software

Key Competencies:

• Exceptional organizational and leadership skills
• Efficient work ethic
• Ability to easily adapt and multitask
• Strong ability to collaborate and perform in a team-oriented environment as demonstrated by prior experience
• Professional and proficient written and verbal communication
• High level of integrity and professionalism
• Goal and results oriented
• Resilient and able to perform under pressure
• Critical thinker
• Reliable
• Strives for excellent standards of quality
• Entrepreneurial spirit
• Commitment to ongoing learning and growth
• Ability to use electronic health records, phone systems, customer resource management software, and more general office computer systems
• Appreciation and respect for principles of diversity, equity, and inclusion. Ability to engage with diverse audiences (age, gender, nationality, race/ethnicity, profession, etc.)