Billing and Collections Specialist

Agrace • Madison, WI

3d

About The Position

The Billing and Collections Specialist is responsible for accurate and timely billing and collection of patient accounts and collaborates with the finance department and other Agrace departments to support an accurate and efficient billing system for the palliative care program. The role also handles billing, collections, and reconciliation of Room & Board charges for patients residing in nursing homes.

Responsibilities include verifying that required billing documentation and insurance coverage are on file; generating claims for all pay sources and secondary payors; monitoring accounts receivable and following up on aging claims; resolving collection issues and filing appeals as needed; documenting collection efforts; recommending write-offs and obtaining required approvals; and collecting patient self-pay balances. The specialist tracks account progress and payments in spreadsheets and records notes in Epic.

For nursing home Room & Board, the specialist bills Medicaid, creates patient accounts, sends invoices and reimbursements to nursing homes, follows up on unpaid Medicaid claims, creates retroactive files, reconciles Medicaid billing and rate calculations, processes paybacks to nursing homes for the 5% for MCOs, and follows up on applicable Medicaid claims and stop-bill errors. The position also participates in relevant work groups, meetings, and committees, stays current with billing regulatory changes, and contributes to system and process improvement. Other duties may be assigned.

Requirements

• High school diploma or GED, or an equivalent combination of education and work experience.
• 3–5 years of customer service experience in a healthcare setting, with prior insurance experience.
• Ability to maintain professional boundaries with patients, families, and co-workers.
• Ability to work effectively and cooperatively with others.
• Ability to lead conversations and resolve conflicts.
• Competence in working with diversity in culture and ethnicity, gender, race, age, and educational background.
• Effective verbal and written communication skills.
• Experience with electronic health records (EHR).

Nice To Haves

• Experience with Epic.

Responsibilities

• Verify that required documentation and insurance coverage supporting billing are on file.
• Generate accurate and timely claims that meet filing requirements for all pay sources and secondary payors.
• Review, analyze, monitor, and collect accounts receivable balances.
• Follow up on aging claims, resolve issues, and file appeals as needed to collect outstanding balances.
• Document collection efforts, recommend write-offs for uncollectable accounts, and obtain required approvals.
• Collect patient self-pay balances based on statements sent.
• Track progress and payments on the accounts receivable spreadsheet and document notes in Epic.
• Bill Medicaid for nursing home Room & Board and create patient accounts.
• Send invoices and reimbursements to nursing homes.
• Follow up on nonpayment from Medicaid for Room & Board and create retroactive files for Medicaid patients.
• Reconcile nursing home billing sent to Medicaid, including rate calculations, using work queues and Forward Health.
• Process paybacks to nursing homes for the 5% for MCOs.
• Review work queues for follow-up on Medicaid claims, including Room & Board Medicaid, Room & Board not Medicaid, and stop-bill errors.
• Participate in work groups, meetings, and committees related to position responsibilities.
• Stay current with billing regulatory changes and contribute to system and process improvement.

Benefits

• Competitive pay with free parking.
• Health, dental, and vision insurance for employees hired for 28 or more hours per week (0.7 FTE or higher).
• Retirement plans with employer matching.
• Generous paid time off and paid holidays.
• Comprehensive onboarding, mentorship, and career development.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED