Healthcare Billing Recovery Case Specialist
Job Code:2020-50-6-012 Location:Sunrise, FL Status:Regular Full Time Responsibilities:
We are seeking highly-skilled, talented medical billing specialists with strong knowledge of medical claim billing, medical terminology and medical coding, forms UB04 and CMS 1500, Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims, and procedural challenges regulations; experience generating or auditing medical claims and billing; proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with carriers to recapture payments.
As a Healthcare Billing Recovery Case Specialist you will work Group Healthcare (GHP) and/or Non-Group Healthcare(NGHP) Provider delinquent accounts under the CMS Medicare Secondary Payer recovery program with responsibilities to include, but not limited to:
- Review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error.
- Leverage your knowledge and expertise in medical billing/COB/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action.
- Initiate correct action with applicable party (health insurance carrier, auto/home/worker's comp insurance carrier, or legal representative) and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
- Updates client and/or company systems with clear and accurate information such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable.
- Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
- Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
- Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
- Follows and complies with company, departmental and client program policies, processes and procedures.
- Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
- Successfully completes, retains, applies and adheres to content in required training as assigned
- Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production and quality.
- Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and, successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)
- Demonstrates Performant core values in performance of job duties and all interactions.
- Correct areas of deficiency and oversight received from quality reviews and/or management.
- Work overtime as may be required.
- May be required to work some Performant holidays due to client requirement.
- Performs other duties as assigned.
Required Skills and Knowledge: NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.
To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Below are representative of the knowledge, skills, and abilities required:
- Knowledge and experience with medical claim billing procedures, medical terminology and medical coding, preferably in a role generating, auditing, recovery and/or researching the same.
- Familiarity with information in forms UB04 and CMS 1500
- Experience with Coordination of Benefits, Third Party Liability, Medicare Secondary Payer
- Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues;
- Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding claims and billing payment.
- Experience in handling Medicare and Medicaid claims.
- Protected patients' privacy, understands and adheres to HIPAA standards and regulations.
- Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude.
- Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
- Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
- Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.).
- Ability to follow process, procedures and regulations in the workplace.
- Ability to effectively perform work independently, and work cooperatively with others to promote a positive team environment.
- Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
- Ability to consistently perform job responsibilities.
- Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
- Completion of Teleworker Agreement upon hire, and adherence to the Agreement (including applicable policies and procedures), which includes, but not limited to, basic home office suitability requirements such as high-speed internet connectivity, appropriate work-space for compliance with confidentiality, HIPAA, safety and ergonomics, and work environment allowing dedicated work-focus without distraction during work hours.
- Possess a personality type that is ethical, friendly, hard-working and proactive.
Job is in a busy standard is performed in an office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for calls,making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse. Reads and comprehends information in electronic (computer) or paper form (written/printed).
- Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment
- Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts
- Consistently communicates on the phone as required primarily within the department and company, and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; head-set is also provided
- Occasionally lift/carry/push/pull up to 10lbs.
Education and Experience: Experience and Education:
- Minimum 6 months of medical billing experience, including Medicare, demonstrating depth of knowledge and capability required for the position.
- Minimum 2 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills.
- High School diploma or GED
Must submit to and pass background check post offer as part of pre-hire process as well as throughout employment with the Company.
Must be able to pass a criminal background checks; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment lists.
Must submit to and pass drug screen.
Must agree, sign and maintain the requirements of the company Teleworker Agreement (and related policies), as well as all Company policies and procedures.
Performant is a government contractor. Certain client assignments for this position may require additional background and/or clearances. This position requires government clearance for CMS.
Job Profile is subject to change at any time.
Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.