Medical Insurance Billing & Reimbursement Analyst I

Medical Insurance Billing & Reimbursement Analyst I

01 Aug 2024
North Carolina, Asheville 00000 Asheville USA

Medical Insurance Billing & Reimbursement Analyst I

Vacancy expired!

Keystone Laboratory Inc. - Asheville, NC An exciting and challenging opportunity awaits a highly qualified Medical Insurance Billing & Reimbursement Analyst I in one of the most beautiful areas in the country, Asheville, NC. About Wolfe, Inc. / Keystone Laboratory Inc.WOLFE, Inc. / Keystone Laboratory Inc., has been in the business of drug detection and workplace protection for nearly 30 years. We provide a comprehensive array of instant drug testing products and accessories, lab services, background screening, program management and training services for organizations of every size and type. In all we do, our number-one objective is to help all of our customers achieve a safe, drug-free workplace—and to do so better and more cost-effectively than anyone else.About AshevilleWhile Asheville retains the charm and friendliness of a medium-sized city, it boasts the amenities of a much larger city. Theater, live music, festivals, excellent restaurants, diverse populations, art galleries, cultural diversions and museums abound. Eclectic art galleries, micro-breweries and cozy cafes can be found at every turn. A food lover's paradise, culinary offerings range from traditional southern comfort food to four-star cuisine. Asheville is also home to America's largest privately-owned home, the Biltmore Estate, and the historic Grove Park Inn. Downtown Asheville is pedestrian-friendly and dog-friendly, and the city’s unique skyline of art-deco style buildings are surrounded by the beautiful Blue Ridge Mountains.Summary/ObjectiveThe Billing and Reimbursement Analyst is responsible for analyzing claim level data to ensure that billing processes, practices, and procedures result in appropriate reimbursement in an effective and efficient manner. Monitors and reports third party payer billing performance to Management. He/she identifies opportunities for reducing third party A/R and improving reimbursement; and works internally across the KBO team and externally with third party payers and billing vendors to leverage these opportunities to improve billing performance. Investigates and resolves key reimbursement issues. This position manages key aspects of the third-party A/R to ensure appropriate financial and billing performance. He/ she supports the KBO and Leadership team in achieving excellent billing and reimbursement performance.Essential FunctionsResponsibilities include but are not limited to the following: Technical Components

Analyzes claim level aging, denial, and payment information to identify trends and potential opportunities for improved reimbursement performance.

Use of aging reports of open claims to identify key reimbursement and A/R reduction opportunities

Use of denial information from adjudicated claims to target key billing and reimbursement issues.

EOB review to ensure that denial and payment data is captured and reported correctly.

Supports and undertakes the development of consistent and efficient billing and denial processes that result in improved reimbursement.

Development of SOPs at the payer and denial level.

Development of appeal processes consistent with payer requirements and based on opportunity for payments.

Coordinates third party billing processes between key constituencies to achieve consistent billing performance.

Develops tools that can be used across departments to support consistent billing practices.

Works effectively with KBO Supervisors on standardizing third party billing practices.

Researches third party billing issues and questions to ensure that billing practices are current and appropriate.

Responsible for developing metrics and scorecards for the measurement of third-party payer billing and reimbursement performance trends.

Regularly publishes scorecards, key issues, and status updates to Billing, Collections, & Revenue Cycle Manager.

Develop systematic approaches for billing third party payers in order to ensure appropriate claims processing.

Responsible for maintaining payer details and for managing set up process for new payers

Maintains full awareness of compliance issues in relation to any insurance contracts, and other insurance regulatory issues. Must report any concerns with applicable government regulation, compliance issues to the Office of Quality.

Produces data essential for the financial review of third-party payers and accounts receivable. Works with Billing, Collections, & Revenue Cycle Manager and Finance team to set write off and reserve criteria for A/R.

Researches regulatory directives and mandates and assists with the implementation of billing practices to meet these requirements, especially as it pertains to Government Payers.

Daily transmission of Check Deposits to the bank using - system and credit card processing.

Daily posting of all Cash Categories including the reconciliation of daily Cash Batches to deposit totals.

Process and monitor Refund Requests and batches through the Accounts Payable department

Post Adjustments for daily requests and bad debt adjustments

Run and post daily credit card reports

Process daily credit card through the Credit Card Housing system for patient prepays and clients.

Assist in management reporting, including daily cash deposit spreadsheet and posting deposits in Great Plains.

Daily Cash Reconciliation.

Daily posting of all Cash categories including payments by check and Credit Cards from Clients, Patients, International Distributors, Consumers, Commercial Insurance, BCBS, Medicare (manual and electronic), Medicaid and Collection Agency. Including the reconciling of daily Cash batches back to the deposit totals.

Pull Electronic Fund Transfer reports from Clearinghouse and post payments to RxNT.

Process and monitor Refund requests and batches through the Accounts Payable department

Post adjustments for daily requests and bad debt write offs.

Running daily credit card reports to obtain credit information from the system.

Processing of daily credit cards through the Credit Card Housing system for patient prepays and clients.

Processing of monthly client and international credit cards through the Credit Card Housing system.

Assisting in management reporting, including daily cash deposit spreadsheet and posting of deposits to Great Plains for accounting reconciliation.

Daily cash reconciliation.

Handling NSF (not sufficient funds) check returns by re-depositing and re-posting payments.

Researching credit card “charge backs”, fax responses and re-post payments if needed.

Preparing checks for deposit – copying and reconciling cash pre-lists to deposit slips.

Transmit payments using - system to the Bank. Responsible for monthly shredding of paper checks.

Maintaining deposit records and files.

Posting payment transfer requests to move and correct payment posting.

Entry of Commercial insurance and BCBS denial codes.

Posting of Commercial and BCBS denial codes and reason comments for “no pay” EOB’s.

Maintains full awareness of compliance issues in relation to any insurance contracts, and other insurance regulatory issues. Must report any concerns with applicable government regulation, compliance issues to the Office of Quality.

Works patient accounts to ensure appropriate adjudication and payment of claims. Processes re-bills, appeals, and processes adjudication information.

Makes corrections to patient accounts in billing system to obtain reimbursement for claims.

Works in clearinghouse system to correct claims and obtain information required to obtain reimbursement for claims.

Uses web resources, imaging system, A/R system, clearing house, and other Keystone systems in the course of working A/R and denials to obtain information required for appropriate reimbursement.

Work denials from third party payers. This includes submitting requested lab results, corresponding with practitioners to obtain medical records and resubmitting claims as needed.

Prepare and submit any insurance secondary billing when appropriate.

Interpretation and posting of all 3rd party insurance (including Medicare and Medicaid) EOB’s and remittances, manually and electronically to both RXNT and to the reimbursement database ((TBD)). Including the reconciling of daily Cash batches back to the deposit totals.

Processes patient accounts to ensure appropriate adjudication, payment, and posting of adjustments/payments.

Forwarding EOB and Insurance remittances to Denial Management Team for review and further action via correspondence coding.

Communicating trends and problems to Supervisor.

Researching credit card “charge backs”, fax responses and re-post payments if needed.

Maintaining EOB and deposit records and files.

Posting payment transfer requests to move and correct payment posting.

Daily, create and complete all Response Posting safety net reports.

Other duties as necessary and delegated by Denial Management/Response Posting Supervisor or Group Leader.

Internal Dependencies

Identifies special projects to reduce A/R and generate incremental cash.

Works with local IT and with software vendor through TMS system to research system settings and capabilities to implement correct and appropriate systematic billing and reimbursement processes.

Other duties as determined by the Billing, Collections, & Revenue Cycle Manager or required to meet goals and objectives.

Works extensively with the AR Leadership Team and with all departments in KBO to ensure consistent billing performance. Frequent contact with Financial Analysts and Accounting as well as other operational departments within the organization. External contact with insurance companies, Government payers, IPAs, re-pricing organizations, TPAs, A/R system vendor, and clearinghouse. Also, may contact physician’s offices and patients.

Daily interpretation and posting of all 3rd party insurance (including Medicare and Medicaid) EOB’s and remittances, manually and electronically to both RXNT and to the reimbursement database ((TBD)).

Re-classing accounts to patient responsibility or secondary insurance when appropriate.

Forwarding EOB and Insurance remittances to Billing Team for review and further action.

Daily Cash Reconciliation.

Communicating trends and problems to Supervisor.

Other duties as necessary and delegated by Billing Supervisor or Group Leader.

Daily posting of all Cash categories including payments by check and Credit Cards from Clients, Patients, International Distributors, Consumers, Commercial Insurance, BCBS, Medicare (manual and electronic), Medicaid and Collection Agency. Including the reconciling of daily Cash batches back to the deposit totals.

Post adjustments for daily cancellations, weekly requests and bad debt write offs.

Running daily credit card reports to obtain credit information from the system.

Processing of daily credit cards through the Credit Card Housing system for patient prepays and clients.

Processing of monthly client and international credit cards through the Credit Card Housing system.

Assisting in management reporting, including posting of deposits to Great Plains for accounting reconciliation.

Researching credit card “charge backs”, fax responses and re-post payments if needed.

Scanning and sending Deposits by Remote Deposit System.

Transporting International deposits to the Bank (when needed).

Assist with prepping and scanning of Explanation of Benefits in Imaging system.

Assist with daily billing processes as needed.

Other duties as necessary and delegated by Billing/ Cash Team Supervisor.

Communicating trends and problems to Supervisor, at a minimum, in a weekly team meeting.

Other duties as necessary and delegated by Billing Supervisor or Group Leader.

Regularly contacts insurance carriers through telephone calls to work third party accounts receivable, also contacts client offices and patients in the course of resolving third party accounts receivable.

Processes, follows up, takes actions in a timely manner based on working denial and aging reports.

Provides excellent customer service to patients, clients and payers.

Assist the cash posting team with EOB and remittance informational needs and questions, including payment and adjustment interpretation.

Other duties as necessary and delegated by Denial Management/Response Posting Supervisor and Keystone Management.

Works closely with all KBO Teams, insurance payers and other Keystone customers.

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