Private Pay Specialist

Capitol Hill Healthcare•Montgomery, AL

4d•Hybrid

About The Position

The Private Pay Biller is responsible for managing the billing and accounts receivable process for residents covered by private pay 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
Previous experience in billing, accounts receivable, or a related financial role, preferably in a healthcare setting with private pay care billing.
Knowledge of private pay 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 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 move intermittently throughout the workday.
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.
Must be able to relate to and work with the ill, disabled, elderly, emotionally upset, and, at times, hostile people within the facility.
Must be able to push, pull, move, and/or lift a minimum of 50 pounds to a minimum height of 5 feet and be able to push, pull, move, and/or carry such weight a minimum distance of 50 feet.
May be necessary to assist in the evacuation of residents during emergencies.

Nice To Haves

Additional education in Finance, Accounting, or a related field is a plus.

Responsibilities

Submit accurate and timely claims to private pay 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 private pay care plans.
Communicate with managed care organizations to ensure authorization requirements are met.
Reconcile payments received from private pay 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 private pay care organizations.
Collaborate with the managed care organization's billing and claims departments as needed.
Prepare and maintain accurate records of private pay 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 private pay care plans.
Communicate relevant billing and authorization information to appropriate departments.
Ensure compliance with private pay care contracts, billing regulations, and industry standards.
Stay informed about changes in billing regulations and private pay care policies.
Maintain organized and up-to-date records of all private pay care billing transactions.
Archive and store documentation according to retention policies.
Provide excellent customer service to residents covered by private pay care plans and liaise with managed care organizations.
Address inquiries, concerns, and facilitate communication between the facility and private pay care partners.
All Other Duties as Assigned.