Responsibilities
- Ability to perform all duties for a Billing Specialist
- Handle complex accounts for both follow-up, appeal, and credit balance resolution
- Follow up on unpaid claims to collect outstanding balances. Investigate and resolve claim denials by reviewing medical records, coding, and payer contracts
- Ability to write and submit escalated appeal letters and represent compelling case to overturn denials with payors, following all billing and compliance regulatory guidelines
- Reviewing daily clearinghouse rejections, resolving, and alerting management of any trends in claim rejections
- Maintain detailed and accurate patient financial records, documenting all account notes and actions taken
- Work with healthcare providers to obtain necessary medical documentation, referrals, or authorizations required for claim processing and reimbursement
- Ability to follow-up on multiple payor types and across multiple states for Commercial, Medicare, Medicaid, Medicaid Managed Care, Blue Cross, Title X, etc.
- Review aged accounts, coordinates and escalates any denial and appeal projects with payors
- Achieve established key performance indicators (KPIs) for position
- Communicate effectively with insurance companies, patients, and healthcare providers to resolve billing issues and ensure accurate claim submission
- Assist Manager to resolve issues and provide support and guidance to the revenue cycle team
- Ensure compliance with all CHN and affiliate policies, as well as all state and federal regulations
- Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
- Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
- Provides positive and development feedback and accountability related to practices including, but not limited to, equity
Requirements
- Bachelor's degree in healthcare administration or equivalent experience
- Minimum of 2 years of relevant account receivable experience
- Previous experience using ICD-10 Medical Coding and Current Procedural Terminology (CPT)
- Knowledge of medical terminology
- Strong analytical and problem-solving abilities
- Proficiency with Microsoft software (Excel, etc.)
- Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment
- Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary
- Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
- Demonstrated dedication to Planned Parenthood’s mission, vision, and values
- Strong interpersonal skills and the ability to build relationships with stakeholders
- Excellent time management, and problem-solving skills
Nice to Have
- Strong General Technology Skills: proficient utilization of Excel, Word, and Windows - environment, Epic, eCW, NextGen or other practice management systems experience a plus
- Medical Billing and Coding certification, Certified Revenue Cycle Representative (CRCR) or other certification a plus
- Willingness to travel in accordance with the needs of the position, as outlined in the essential functions. Compliance with all CHN travel policies, including safety guidelines while operating a personal vehicle.
Additional Information
- Commitment to advancing race (+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society
- Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
- Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
- Strong sense of accountability to equitable practices
- Understanding of the impact of identity dynamics on organizational culture
- Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards
