Billing Specialist

🕒 Abril 15

🌵 Arizona – Remoto

🌵 Arizona – Remote

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

📊 Especialista em Faturamento

🚫👨‍🎓 Sem graduação necessária

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Healthcare Outcomes Performance Co. (HOPCo)

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

🤝 B2B

☁️ SaaS

💰 Private equity em 2019-02

B2B • SaaS

A Healthcare Outcomes Performance Co. (HOPCo) é a maior organização de cuidados ortopédicos baseados em valor nos EUA, especializada na entrega, gestão e criação de valor em cuidados abrangentes do sistema musculoesquelético (MSK). Liderada por médicos e executivos ortopédicos, a HOPCo opera uma rede clínica integrada de MSK acreditada e oferece soluções de parceria prática e de sistema de saúde, programas de saúde populacional voltados para o pagador e cuidados baseados em valor, análises e relatórios de resultados, e ferramentas digitais de engajamento do paciente para alinhar partes interessadas, melhorar resultados e reduzir os custos totais de MSK.

Descrição

• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers. • Review and prepare claims for manual and/or electronic billing submission. • Reviews insurance rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding rejections. • Correct and identify billing errors and resubmit claims to insurance carriers. • Update CAS segments on secondary electronic claims as needed. • Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans. • Verifies receipt of claim with insurance plans, determining the next appropriate action step. • Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients. • Obtains and attaches referrals to appointments/charges. • Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals. • Identifies and communicates trends and/or potential issues to the management team. • Follows and maintains all HOPCo policies and procedures.

🎯 Requisitos

• High school diploma/GED or equivalent working knowledge preferred. • Minimum of two to three years of experience in medical billing. • Prior experience working on claim errors in a claims management system preferred. • Strong knowledge of resolution to payor edit reports, and reconciliation of clearinghouse and payor acceptance reports. • Candidates with knowledge of ANSI formatting preferred. • Knowledge of ICD-9, ICD-10, HCPS, and CPT coding, medical terminology, Medicare reimbursement guidelines, billing practices. • Knowledge of government regulatory requirements and commercial contracts. • Advanced computer knowledge, including Window based programs.

🏖️ Benefícios

• Equal Opportunity Employer