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Full-time on-site Medical Biller for Non-Profit organization. The ideal candidate will have a minimum 2 years’ experience and will work under the direction of the Billing Manager. In this role, you will enter and maintain all pertinent information which relates to billing and collection of Medicaid, DDD Services, PerformCare, private pay, and licensed practitioners with respect to insurance companies for services performed by Pillar Care Continuum. This position is part of a 4-person billing team and a member of the broader Finance department. Familiarity with the Supports Program and Procedure Manual a plus and confidentiality and adherence to HIPAA guidelines a must!
RESPONSIBILITIES:
- Collect, review, and maintain all required authorizations to prepare to bill to Gainwell Technologies, Medicaid, insurance companies or state agencies.
- Work within the program to set up any needed ID numbers, procedure codes, or modified mapping to accommodate agency/program changes in and outside of CareLogic billing system and work closely with the IT System Administrator to ensure a proper setup and results.
- Review claims for accuracy, completeness, and obtain any missing information required or make corrections to produce a billable clean claim.
- Prepare and submit claims either electronically or by paper to Gainwell Technologies/ Medicaid or other agency/insurance companies.
- Process payments and denials either electronically or manually.
- Review remittance advice for payment errors, denials, underpayments, voids, and adjustments and resubmit as needed.
- Process voids and reconcile recoups to ensure accuracy.
- Create private pay monthly invoices and generate collections letters to clients regarding overdue balances.
- Work with client families to develop self-pay arrangements and payment plans as needed
- Update and maintain Open Issue Log and work closely with the Program Coordinators both internally and with outside agencies to resolve issues
- Initiate the Insurance Appeal Process and form FD-999 submission requests as well as any necessary follow-up and system documentation
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
KNOWLEDGE/SKILLS:
- High School or GED equivalent
- Minimum 2+ years of experience medical billing, specifically Medicaid billing of DDD related services
- Strong computer skills, including MS Office and Excel
- Knowledge of Gainwell (Medicaid NJ), CareLogic is preferred, but not required.
- Understanding of new NPI numbers setup, taxonomy codes and Medicaid ID numbers
- Adhere to ethical standards, policies and procedures, including HIPAA regulations
- Ability to establish and maintain proper working relationships both externally and internally
- Attention to detail and strong communication skills both written and verbal
- Maintain a safe working environment
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