Open Until Filled
Job Code: 29-2072
Status: Full-Time, Permanent
Location: Health Services
Department: Business Office
Reports To: Accounts Receivable Supervisor
SUMMARY: Under the direction of the Accounts Receivable Supervisor, the Billing Specialist in Third Party Billing and Accounts Receivable will compile, process and maintain third party billing of and Accounts Receivable of Health Services in a manner consistent with medical, administrative, ethical, legal and regulatory requirements in all areas of the Business Office. The Billing Specialist assumes responsibility for third party billing and accounts receivables, including the timely submission of claims to third party payers, rebilling, posting payments and adjustments, aged/open claims follow-up, and denial management.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Responsible for the accurate and timely preparation and submission of claims to third party payers and responsible parties according to Business Office policies and procedures.
- Responsible for maintenance and control of unbilled claims for accounts receivables.
- Responsible for the re-submission of denied/corrected claims and follow up on aged/open claims according to third party billing guidelines.
- Notifies supervisor of all claims deemed un-billable (i.e. beneficiaries), along with reasons and supporting documentation required for an adjustment for reconciliation of claims.
- Maintains up-to-date knowledge of third party billing policies and procedures, (including Medicare, Medicaid, and private insurance).
- Payments must be posted within 72 hours from receipt of supporting documentation. An A/R log shall be kept to identify when batches were received and posted. Unposted and unallocated batches will be reviewed, researched and worked daily.
- Reconciles account balances; reviews records and source documents to identify sources of discrepancies; and determines the entries required to bring the account to balance.
- Performs third party billing collection posting in RPMS. Receives and reviews all explanation of benefits and remittances from third party payers. Identifies and records proper check numbers on each batch and posts to the appropriate departments. Audits all documents received for completeness and accuracy; performs analysis to determine whether payments are complete, timely filed and in accordance with Business Office policies and procedures.
- Reviews Age Report for all third party payers and completes follow-up on unpaid bills in Third Party Billing within 45 days.
- Performs all claims billing and follow-up for Partridge House.
- Examines accounts or resolves difficult reconciliation requiring an analysis of adjustments and corrective entries in the RPMS system.
- Prepares and Submits Medicare credit balance report.
- Attends meetings/trainings as requested by the Business Office Manager/Accounts Receivable Supervisor.
- Other related duties as assigned (including Patient Registration, Accounts Receivable, and Medical Records Coding).
SUPERVISORY RESPONSIBILITIES: There are no supervisor requirements for this position.
EDUCATION and/or EXPERIENCE: Medical office and/or billing experience preferred, and High School diploma or equivalent.
OTHER SKILLS and ABILITIES: Strong oral and written communication skills required. Must have excellent computer skills including word and excel.
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Due to the sensitive nature of information within the Business Office, must maintain strict confidentiality at all times.
REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Applicants must submit letter of interest, resume, supporting documents (certificates, degrees, licenses) and proof of native preference eligibility (Tribal Identification Card or Status Card or letter) by email to firstname.lastname@example.org or by mail to Human Resources, Saint Regis Mohawk Tribe, 71 Margaret Terrance Memorial Way, Akwesasne, NY 13655. Due to our network security, we are unable to open hyperlinks. Applicants will need to attach their documents as PDF or WORD files if emailing. Applicants must clearly outline that they meet the qualification requirements on their resume.
NATIVE PREFERENCE POLICY
The Saint Regis Mohawk Tribe strives to be an equal opportunity employer dedicated to the policy of nondiscrimination based on race, sex, marital status, sexual orientation, religion, national origin, age, physical disability, veteran status or any other non-job related factor. Among qualified applicants, the SRMT will give preference to the qualified native applicant.
DRUG TESTING POLICY
The successful applicant for employment must submit to and pass a drug test for illegal substances prior to employment being confirmed.
Some positions require candidate(s) to successfully pass a criminal background check prior to beginning employment, used solely for employment related purposes.
A list of qualified candidates is created from interviews that may be used to appoint individuals to similar positions within the Saint Regis Mohawk Tribe for a period of six months.
Testing in the applicable skills may be required as part of the interview process.