Revenue Cycle Billing & Denials Specialist

ACCRA Management Group LLC•Minnetonka, MN

19h•$24 - $29•Remote

About The Position

The Billing & Denials Specialist is responsible for the middle to end of revenue cycle functions including claims billing, claims review, denial management, reconciliations, appeals, issue resolution, adjustments and write offs. The ideal candidate will have familiarity with the prior authorization process and experience in claims review with Minnesota Medical Assistance (MA) Electronic Remittances and have a working knowledge of the Minnesota Prepaid Medical Assistance Program (PMAP), Minnesota Senior Health Options (MSHO) program, and the various payers associated with them. This role is essential to maintaining healthy cash flow, regulatory compliance, and operational excellence for our FMS revenue cycle division including claims associated with the State of Minnesota Budget Model, Community First Services and Supports (CFSS), and Elderly Waiver Programs.

Requirements

Associate’s degree and at least 2 years of relevant experience or similar education and experience required.
Proven Revenue Cycle or Practice Management software knowledge and experience required.
Proficient with Microsoft Office including Word and Excel.
Proficient in Microsoft Outlook and Teams.
Strong knowledge of third-party payers, as well as laws, regulations, and guidelines both state and federal as they pertain to healthcare providers.
Understanding of CPT and ICD-10 coding principles and guidelines as related to claims processing.
Understanding of authorizations, and appropriate application of service units and modifiers.
Excellent interpersonal and communication skills and strong ability to collaborate effectively.
Strong analytical and problem-solving skills.
Excellent organization, communication and follow up abilities.
Ability to work in a fast-paced, virtual business environment.
Ability to meet metrics and key performance indicators as applicable to general RCM benchmarks.
Ability to work independently at times with little supervision.

Nice To Haves

Experience in home care, SNF, or behavioral health billing preferred.
Proven experience with MNITS, Availity, and clearinghouse usage.
Previous remote work experience preferred.

Responsibilities

Review claims to prepare for billing to both MA and various PMAP/MSHO payers to ensure all billed services are supported by authorizations.
Monitor claim status and follow up on rejections, denials and unpaid claims.
Perform claim audit reviews via assigned workbooks for assigned MA and PMAP/MSHO plans on all accounts outstanding over 30 days.
Review remittances for accuracy, denials, adjustments, write offs and spend downs.
Ensure proper authorization and billing for employer-related goods and services, including billing and reimbursement of invoiced services associated with Consumer Support Grant (CSG) and Consumer Directed Community Supports (CDCS).
Correct billing errors and resubmit or send replacement claims as necessary.
Review unbilled reports for MA and PMAP/MSHO plans.
Apply appropriate adjustments and write offs as required.
Answer billing queue calls as pertains to assigned payers.
Communicate with MNITS, payers, clearinghouse, and internal stakeholders regarding billing and denial issues.
Maintain compliance with Minnesota DHS billing compliance regulations regarding timely filing, accurate documentation, proper use of taxonomy and NPI codes, and avoiding fraud, waste and abuse as outlined by state and federal agencies.
Understand and comply with FMS, CFSS, and Medicaid Elderly Waiver requirements.
Maintain strict confidentiality and full HIPAA compliance.
Meet/Exceed stated goals and metrics associated with the assigned workflow.
Identify and escalate issues regarding tracking worksheets, at-risk accounts, incorrect database errors, communication, and payers to direct supervisor.
Additional Revenue Cycle projects and job duties as needed.