Billing & Collections Analyst

Nazareno Services Inc

About The Position

The Billing and Collections analyst is responsible to receive the case once DME delivery is completed in order to start and complete the process of billing, collections, cash posting and reconciliation. Is also responsible for maintaining the Revenue Cycle Manager up-to-date of any situation that affects the cash flow and visits insurance carriers for outstanding claims.

Requirements

A certification in Billing for Medical Plans is required and or a Medical Assistant course, preferred.
Three (3) years of related experience in insurance carriers accounts receivable and payment reconciliations.
Experience with claims audits.
Computer literate MS Office (Word, excel, power point and outlook)
Knowledge of Proclaim billing system (Assertus).
Knowledge of electronic medical records.
Knowledge in insurance carriers billing requirements (manual and electronic)
Knowledge in insurance carriers appeals and adjustments processes.
Detail oriented, organizational and work under pressure skills.
Super interpersonal relations skills, and excellent communication with insurance carriers.
Bilingual (Spanish and English).

Responsibilities

On Proclaim (company’s billing system) review information in patient accounts and enter patient demographic and insurance information as needed.
Utilize available resources to gather complete insurance data including use of insurance websites.
Before creating a claim on the billing system, review that all billing required documents are attached to CRM or OPEI, CPT, Dxs. and any other information that it’s mandatory to bill charges.
Complete insurance verifications as needed.
Ensures all charges are initially submitted within 5 business days of the date of service, according to Medicare and Medicaid regulations and receive by payers.
Bill charges to patients when necessary.
Monthly, review and analyze the A/R Aging; and conducts audits of balances pending.
Processes billing weekly; notify Revenue Cycle Supervisor when errors occur that prevent complying with the deadlines.
Analyze and resolve insurance denials by examining provider documentation according to the payer timeframes and procedures.
Track and trend claim denials and identify root causes to support process improvements and reduce future denials.
Prepare various billing reports assigned and inform any issues back to the Revenue Cycle Supervisor.
Handles escalated or complex claims according to payers’ appeals levels.
Respond to escalated billing inquiries from patients, insureds and internal staff.
Apply into the billing system all electronic and manual payments within the month it is received.
Process write-offs, credit memos, other billing adjustments, return premium disbursements (refunds), process select cash application transactions including payment reversals, payment transfers, and modify payment distribution.
Record claims deductible charges and maintain automatic payment set-ups.
Weekly, visits the payers to discuss any issues that results in denials.
Maintain an excellent communication with medical office, patients and payers’ representatives.
Work closely with all internal areas to assure a proper process.
Meet production metrics and daily workflow.
Other duties and responsibilities as assigned.