at Spectrum Healthcare Partners in Portland, Maine, United States
COMPANY OVERVIEWSpectrum Healthcare Partners is Maine’s largest multi-specialty, physician-owned and directed professional organization and is comprised of over 200 physicians practicing in the areas of anesthesiology, orthopedics, pain management, pathology, radiation oncology, radiology, and vascular & interventional services. Spectrum provides services at many of Maine’s hospitals throughout the state and in eastern New Hampshire. Hours: Monday – Friday. Hours: Between 7:00 AM – 5:00 PM. This is a hybrid/remote position with option to work some days remotely. On-site training is required. POSITION SUMMARY Ensures appropriate and complete reimbursement from patients and third-party payers through billing, research, collection, and follow-up of assigned accounts receivables encounters/visits. Ensures claims are submitted accurately and timely; outstanding accounts receivables are monitored and followed up in a frequency that ensures timely and accurate payment/adjustments. Responsible for resolving denials and working with insurance companies and government payers to secure accurate and timely payments for the services rendered. Completes tasks in accordance with practice policies, government regulations and insurance contracts. SUPERVISORY RESPONSIBILITIES (if any) None ESSENTIAL FUNCTIONS
+ Processes full life cycle of claims for payment from all insurance companies and government payers.
+ Submits paper and electronic claims to third party payers daily. Uses knowledge of insurance carriers’ policies to ensure claims are submitted accurately and correctly to obtain complete and appropriate reimbursement in a timely manner.
+ Reviews and addressed daily claim scrubber/edit reports. Ensures daily claims submission files are submitted and accepted by payer or payer clearinghouse.
+ Prepares and submits secondary (& tertiary) claims with primary payer Explanation of Benefits (EOB).
+ Works incoming mail including denial letters regarding unpaid insurance claims and processes requests from insurance companies.
+ Completes follow up activities with insurance payers to ensure balances are resolved timely and patient balances are billed promptly.
+ Communicates with patient and insurance company representatives via telephone or online follow up regarding open claims/outstanding balances.
+ Manages and works the claim edits, various billing, follow up and denial work queues, maintaining practice standards and adherence to payer requirements.
+ Completes denial appeals thoroughly and timely, working with providers and coding staff and insurance payers, as appropriate.
+ Prepares all documentation to support an adjustment request. Submits adjustment requests in accordance with organizational standards.
+ Provides patient statements when requested by the patient or the patient’s legal representative.
+ Reviews printed charges/patient statements prior to mailing to ensure accuracy and efficiency.
+ Prepares and processes refunds, corrected claims and or takebacks to patients and insurance companies; if not otherwise assigned.PRIMARY RESPONSIBILITIES
+ Reviews monthly and other reports to understand issues and trends and works with supervisor/revenue cycle leader to develop an action plan to address them.
+ Initiates reviews when reimbursement levels are low or patient balances are high.
+ Stays current with insurance changes and communicates any new changes to Supervisor/revenue Cycle Leader in a timely manner.
+ Assists with answering incoming calls from patients and staff regarding patient payments and/or account questions or claim related questions.
+ Works with front desk staff, scheduling and authorization staff to ensure that correct billing information has been collected during the scheduling and or check-in process.
+ Provides front desk ongoing education on insurance policies so they can educate patient.
+ Maintains patient confidentiality according to state and federal and company regulations.
+ Actively supports departmental and corporate strategic plans.
+ Maintains productive and cooperative working relationships with others in the department and organization.
+ Keeps abreast of current issues involving patient care or practice issues by attending and participating in department, team and practice meetings.
+ Demonstrate professionalism always.
+ Displays cooperative behavior and interacts positively and effectively with others to promote a team environment.
+ Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues.
+ Performs other duties necessary to maintain the overall efficiency and continuity of the revenue cycle and practice.QUALIFICATIONS
+ High school graduate or equivalent certification
+ 1 – 3 years or more of previous Accounts Receivable experience, or other related practice experience required; experience utilizing insurance web products to obtain patient eligibility, claims status, payer websites and benefits required
+ Certified training specific to medical insurance billing and coding beneficial; CPC, CPAT or CRCS helpful
+ Knowledge of CPT and ICD10; knowledge of health insurance billing and claims processing.
+ Proficient computer skills including Microsoft Office; preferably Office 365. Previous experience with practice electronic medical record systems and physician management systems desired.
+ Excellent customer service skills
+ Ability to make well-reasoned decisions, both independently and as part of a team; Ability to work independently and as an effective member of a team
+ Ability to follow-through to meet patient, physician, and/or practice needs
+ Ability to use discretion in handling confidential information
+ Ability to work collaboratively and effectively with individuals at all levels of the organization
+ Excellent organizational skills with attention to detailPHYSICAL DEMANDS / WORK ENVIRONMENT
+ Operation of various office equipment; fax machine, telephone & voice mail system, stationary/lap top computer, scanner, e-mail system, cell phone, pager, and copier
+ Light lifting of paperwork, folders or other general record keeping materials
+ Lifting of mail bins and boxes up to 50 lbs.
+ Occasional travel to various sites of service
+ May be required to sit or stand for extended periods of timeBENEFITS AND PERKS
+ Health Insurance (80% company paid)
+ Health Savings Account Match ($3,000 family plan / $1,625 individual plan)
+ Dental & Vision Insurance Plans
+ 401(k) Match and Profit Sharing Plan
+ Life and Accidental Death and Dismemberment Insurance
+ Long-term Disability Insurance
+ Short-term Disability Insurance
+ Generous paid time off
+ Voluntary, Employee-Paid Benefits
+ Medical Reimbursement Plan
+ Dependent Care Plan
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