Managed Care Biller

Capitol Hill Healthcare • Montgomery, AL

4d • Onsite

About The Position

The Managed Care Biller is responsible for managing the billing and accounts receivable process for residents covered by managed care plans within our Skilled Nursing Facility. This role involves working with managed care organizations, processing claims, and ensuring accurate and timely reimbursement.

Requirements

• High school diploma or equivalent
• Knowledge of managed care billing processes, claims submission, and accounts receivable management.
• Strong attention to detail and accuracy in data entry.
• Effective communication and interpersonal skills.
• Proficiency in using billing software and Microsoft Excel.
• Must be able to read, speak, and understandably write the English language.
• Must be able to cope with the mental and emotional stress of the position.
• Must function independently, and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.
• Must meet the general health requirements set forth by the policies of this facility, which include a medical and physical examination if the position requires.

Nice To Haves

• Additional education in Finance, Accounting, or a related field is a plus.
• Previous experience in billing, accounts receivable, or a related financial role, preferably in a healthcare setting with managed care billing.

Responsibilities

• Submit accurate and timely claims to managed care organizations for services provided to residents.
• Verify that all necessary documentation and authorizations are in place before claim submission.
• Verify and obtain pre-authorizations for services covered by managed care plans.
• Communicate with managed care organizations to ensure authorization requirements are met.
• Reconcile payments received from managed care organizations with billed amounts.
• Investigate and resolve discrepancies in payments and denials.
• Monitor and manage accounts receivable for residents covered by managed care plans.
• Follow up on overdue payments, denials, and underpayments.
• Address billing inquiries and payment-related concerns from managed care organizations.
• Collaborate with the managed care organization's billing and claims departments as needed.
• Prepare and maintain accurate records of managed care billing and collections.
• Generate reports on accounts receivable and billing performance for managed care plans.
• Collaborate with the admissions and finance teams to ensure accurate and timely billing for residents covered by managed care plans.
• Communicate relevant billing and authorization information to appropriate departments.
• Ensure compliance with managed care contracts, billing regulations, and industry standards.
• Stay informed about changes in billing regulations and managed care policies.
• Maintain organized and up-to-date records of all managed care billing transactions.
• Archive and store documentation according to retention policies.
• Provide excellent customer service to residents covered by managed care plans and liaise with managed care organizations.
• Address inquiries, concerns, and facilitate communication between the facility and managed care partners.
• Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served.
• Must be a supportive team member, contribute to and be an example of teamwork and team concept.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.
• Must be able to relate information concerning a resident’s condition.
• Must not pose a direct threat to the health or safety of other individuals in the workplace.
• Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility.
• May be necessary to assist in the evacuation of residents during emergencies.
• All Other Duties as Assigned.

Benefits

• Works beyond normal working hours and on weekends and holidays when necessary.
• Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.).
• Attends and participates in continuing educational programs.
• The facility is an equal opportunity employer and recognizes that an individual with a disability may require accommodation to enable the individual to successfully perform a job function.

What This Job Offers

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