• Job Description:

• Responsible for timely and compliant Private Duty billing, authorizations, and reimbursement for designated region
• Work directly with revenue cycle director, billing compliance coordinator, agencies, and intermediary to facilitate billing claims
• Obtain authorizations as needed
• Prepare, audit, and submit claims electronically for appropriate payment
• Follow up on outstanding claims and take appropriate action for timely payment
• Collect necessary information to prepare claims, coordinating with agencies when appropriate
• Bill and submit clean claims electronically and follow up with the Payer
• Process, collect, and manage account payments
• Monitor claims daily, report totals
• Research, correct, and re-submit rejected and denied claims
• Follow-up on corrections and report adjustments using revenue cycle management tool
• Monitor and maintain assigned accounts
• Review billing reports to maintain accurate AR balances
• Document follow-ups on claim outstanding balance until final resolution is reached
• Keep accurate and orderly records for all billing and accounts receivable activity
• Conduct pre-billing audits as assigned
• Proactive in identifying potential reimbursement issues while ensuring effective problem resolution
• Coordinate with the Agency and Billing Compliance Coordinator on relevant process issues impacting billing
• Report any billing issues that develop into trends to immediate supervisor
• Answer questions from patients, agency staff, and insurance companies
• Interpret and process Explanation of Benefits when needed
• Professionally make outbound calls while improving customer relations
• Maintain knowledge of current industry standards related to billing and cognizant of new regulations
• Requirements:
• Required Private Duty billing experience
• Required Authorization request experience
• Preferred, AlayaCare, Waystar, Availity experience
• Ability to communicate effectively both verbally and in writing
• Excellent customer service skills
• Private Duty billing and denial management skills, including VA
• Excellent PC skills, Email, Internet Research, Word Processing, Spreadsheets, PDF, and Patient Accounting software systems knowledge (preferably CareVoyant)
• Knowledge in accessing the payer portals and reaching out to payers
• Claims preparation and audit, including prebill audits for billing compliance
• Knowledge of billing regulations and claim submission
• Detail-oriented and effective in problem resolution and escalation
• Able to organize duties and functions in a highly effective manner to achieve productivity and quality standards
• Knowledge of regulations and publications for Private Duty, skilled and unskilled care
• Ability to post payments and follow up on discrepancies in payments.
• Benefits:
• Competitive pay
• 401k
• Health & life insurance
• Flexible schedules & career growth opportunities
• Continuing education & recognition programs
• Supportive, family-like team culture