Healthcare Reimbursement & Billing Specialist

State of North Carolina • Raleigh, NC

357d • $35,984 - $62,971

About The Position

This position is critical to maintain the Healthcare Enterprise Accounts Receivable Billing and Tracking system and meet Federal and State Reporting Requirements for thirteen State Owned and Operated Healthcare Facilities. This position is responsible for maintenance of complex inpatient healthcare accounts including a variety of accounting and patient records, determining appropriateness of all charges, payments, and adjustments maintained on specialized billing system, billing and collections from multiple third-party payors.

Requirements

• Working knowledge of electronic 'inpatient' and 'outpatient' Healthcare billing systems; 'compiling' and submission of paper inpatient UB04 and outpatient CMS 1500 claim forms.
• Documented experience working with Version 005010 EDIx12 electronic healthcare transactions sets, including 837I, 837P, 835I and 835P and use of claims clearing houses.
• Demonstrated experience billing healthcare patient accounts and collections including but not limited to Medicare, Medicare HMO, Medicaid Managed Care Organizations, NC Tracks and other commercial insurers, patients, and guarantors.
• Working knowledge of Federal and NC General Statutes and Guarantor eligibility and reporting requirements.
• Demonstrated knowledge of accounting, auditing inpatient and outpatient healthcare accounts, and cash management; A/R and A/P.
• Demonstrated knowledge of Microsoft Office, proficiency in Excel.
• Demonstrated ability to communicate with all aspects of the public.

Nice To Haves

• Proven working experience in healthcare accounting related field; A/R and A/P.
• 3 years direct experience in healthcare third party billing (Commercial, Medicare and Medicaid).
• 3 years experience auditing Healthcare patients accounts; self-pay and third-party balances.
• Working knowledge of Affinity Patient Accounting System.

Responsibilities

• Determining the appropriateness of all manual and system generated transactions (room and bed charges, payments and adjustments) that are maintained on the Affinity Healthcare Patient Accounts and Billing System.
• Submit CMS recognized electronic EDI X12 5010 837I, 837P transactions utilized for inpatient billing practices through a claim clearing house and, paper formats (UB04 and CMS1500).
• Healthcare claims compilation, billing and collections from Medicaid Managed Care Organizations, NC Tracks, and other third-party payers; verify integrity of claims by ensuring appropriate authorizations received for services provided. Follow up on outstanding claims, submit adjustment claims as needed.
• Analyze healthcare Medicare, NC Tracks, Medicaid, and Commercial Insurance Explanation of Benefits, using paper and EDI X12 5010 835I and 835P electronic formats.
• Accurately report outstanding billable and uncollectible charges using system generated reports; compile comprehensive reports used in monthly receipt projection analysis.
• Position interprets State and Federal policies and procedures as they apply to guarantor and third-party billing practices.

Benefits

• Health insurance options
• Standard and supplemental retirement plans
• NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis)
• Paid vacation
• Sick leave
• Community service leave
• Paid parental leave for eligible employees

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Executive, Legislative, and Other General Government Support
• Education Level: Associate degree