Medical Biller Collections Specialist

Job Description

Job Description

We are a boutique Durable Medical Equipment Company that supplies enteral nutrition formulas including medical foods for inborn errors of metabolism.

We are seeking a remote experience medical biller collections specialist, preferably with a DME and enteral supplies background.

Hearts Enteral is the sister company of our non-profit organization Compassion Works Medical. Our mission is to help fight the challenges of healthcare reimbursement for people who struggle with rare diseases and conditions that require enteral nutrition and medical foods to sustain and prolong their lives.

The position is based on a 1099 and not a W-2. There are full-time and part-time positions.

Hearts Enteral DME is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, creed, color, age, sex, religion, or national origin.

MUST have 3 years minimum experience with medical billing with HCPCS codes and claims submissions.

JOB : Navigate between patients, healthcare providers, and insurance companies (also known as payers) to arrange for reimbursement of healthcare services.

The medical billing and collection specialist is responsible for ensuring accurate billing, timely submission of electronic and / or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, and posting adjustments and collections of Medicare, Medicaid Managed Care, and commercial insurance payers.

The medical billing and collection specialist must possess critical thinking skills and an understanding of Medicare, and Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments based on payer contracts or government regulations.

In addition, the medical billing and collection specialist must demonstrate proficiency with the billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

MAJOR DUTIES & RESPONSIBILITIES :

• Responsible for charge and payment entry within Electronic Health Records.
• Responsible for correcting, completing, and processing claims for all payer codes;
• Analyze and interpret that claims are accurately sent to insurance companies;
• Perform follow-up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports;
• Process appeals online or via paper submission;
• Assist in reconciling deposit and patient collections;
• Assist with billing audit-related information;
• Process refund requests;
• Attend weekly meetings to streamline work performance and action plans;
• Communicate with the billing and credentialing coordinator to identify and resolve audit review issues;
• Identify trends, and carrier issues relating to billing and reimbursements. Report findings to the Team Lead and / or Supervisor;
• Research, record findings, and communicate effectively with the Manager to achieve optimum performance;
• Pursue and participate in education to remain current with changes in the Healthcare industry;
• Maintain patient confidence and protect medical office operations by keeping patient information confidential; HIPAA Compliance.
• Contribute to team effort by accomplishing related results as needed;
• Promote effective working relations and work effectively as part of a team to facilitate the department’s ability to meet its goals and objectives;
• Demonstrate respect and regard for the dignity of all patients, families, and fellow employees to ensure a professional, responsible, and courteous environment;
• Perform other duties as assigned to support Hearts Enteral's Mission, Vision, and Values.
• Compassionate towards others.

Required experience : Should have some background in the DME industry and Familiarity with the various payers and health plans including deadlines and prior authorization before supplying our products and billing claims.

Including clearing houses. Understand HIPAA compliance and follow the rules.

QUALIFICATION REQUIREMENTS :

• Minimum of three years of related experience in medical billing or any collections industry. Preferred but not required in a DME industry.
• Previous experience with an Electronic Medical Record a plus, eClinical Works, Office Ally, Availity, Navinet, and all EMR-related experience preferred;
• Customer service driven;
• Understanding of medical terminology and insurance laws / guidelines;
• Excellent organization and time management skills along with excellent oral and written communication skills;
• Strong team player;
• Ability to learn quickly, build and maintain long-term relationships, and work with minimal supervision;
• Strong written and verbal communication skills; strong analytical, organizational, and time management skills required
• Office Microsoft 10 business, word, excel, cloud drives.

SKILLS :

EDUCATION and / or EXPERIENCE : High School Diploma equivalent required, Associate Degree preferred. Certified Biller and Coder strongly preferred.

REASONING ABILITY : Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

LEADERSHIP RESPONSIBILITIES : No supervisory or direct people management responsibilities. May provide occasional work guidance, technical advice, and training staff.

WORK COMPLEXITY / INDEPENDENT JUDGEMENT :

Work tasks are often straightforward, routine, structured, and guided by established policies

and procedures. Little, if any, independent judgment is required, outside of making basic

choices in the selection and application of established methods. The job received frequent,

ongoing supervision.

PROBLEM-SOLVING :

Decisions are made on routine matters affecting a few individuals and usually within the

confines of the job's own department. Specific job activities and results are typically

reviewed closely. There are limited requirements for developing new ideas or changes in

methods, procedures, or services.

COMMUNICATION / INTERACTIONS :

Information sharing - gives and receives information such as options, technical direction,

instructions and reporting results. Interactions are mostly with customers, own supervisors, and coworkers in their own and other departments.

IMPACT OF DECISIONS :

Follow rules and procedures. Decisions can have minimal or no impact on Hearts Enteral.

Errors can be readily detected, usually by the employee, and, if made, would result in minor

expense for correction.

CUSTOMER RELATIONSHIPS :

MUST have a strong compassion for people. Follow through with customer inquiries, requests, and complaints. Forward difficult and nonroutine inquiries or requests to the appropriate level for resolution.

OTHER : THE POSITION STARTS ON A 3-MONTH PROBATION PERIOD WITH FULL OPPORTUNITIES FOR GROWTH

Company Description

Hearts Enteral DME is the sister company of our non-profit organization Compassion Works Medical. Our mission is to help fight the challenges of healthcare reimbursement for people who struggle with rare diseases and conditions that require enteral nutrition and medical foods to sustain and prolong their lives.

Web. www,heartsenteral.com. www.compassionworksmrs.com.

Company Description

Hearts Enteral DME is the sister company of our non-profit organization Compassion Works Medical. Our mission is to help fight the challenges of healthcare reimbursement for people who struggle with rare diseases and conditions that require enteral nutrition and medical foods to sustain and prolong their lives.

Web. www,heartsenteral.com. www.compassionworksmrs.com.