Managed Care Biller

Job Details:

Job Location:

Capitol Hill Healthcare Center Inc - Montgomery, AL, Education Level: High School, Salary Range:
Undisclosed, Job Shift: First, Job Summary

The Managed Care Biller is responsible for managing the billing and accounts receivable process for residents covered by managed care plans within our Skilled Nursing Facility. This role involves working with managed care organizations, processing claims, and ensuring accurate and timely reimbursement.

• Submit accurate and timely claims to managed care organizations for services provided to residents.
• Verify that all necessary documentation and authorizations are in place before claim submission.

• Verify and obtain pre-authorizations for services covered by managed care plans.
• Communicate with managed care organizations to ensure authorization requirements are met.

• Reconcile payments received from managed care organizations with billed amounts.
• Investigate and resolve discrepancies in payments and denials.

• Monitor and manage accounts receivable for residents covered by managed care plans.
• Follow up on overdue payments, denials, and underpayments.

• Address billing inquiries and payment-related concerns from managed care organizations.
• Collaborate with the managed care organization's billing and claims departments as needed.

• Prepare and maintain accurate records of managed care billing and collections.
• Generate reports on accounts receivable and billing performance for managed care plans.

• Collaborate with the admissions and finance teams to ensure accurate and timely billing for residents covered by managed care plans.
• Communicate relevant billing and authorization information to appropriate departments.

• Ensure compliance with managed care contracts, billing regulations, and industry standards.
• Stay informed about changes in billing regulations and managed care policies.

• Maintain organized and up-to-date records of all managed care billing transactions.
• Archive and store documentation according to retention policies.

• Provide excellent customer service to residents covered by managed care plans and liaise with managed care organizations.
• Address inquiries, concerns, and facilitate communication between the facility and managed care partners.

• High school diploma or equivalent; additional education in Finance, Accounting, or a related field is a plus.
• Previous experience in billing, accounts receivable, or a related financial role, preferably in a healthcare setting with managed care billing.
• Knowledge of managed care billing processes, claims submission, and accounts receivable management.
• Strong attention to detail and accuracy in data entry.
• Effective communication and interpersonal skills.
• Proficiency in using billing software and Microsoft Excel.

• Works in office area(s) as well as throughout the nursing service area (i.e., drug rooms, nurses’ stations, resident rooms, etc.).
• Moves intermittently during working hours.
• Is subject to frequent interruptions.
• Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances.
• Is subject to hostile and emotionally upset residents, family members, personnel, and visitors.
• Communicate with the medical staff, nursing personnel, and other department directors.
• Works beyond normal working hours and on weekends and holidays when necessary.
• Is subject to call back during emergency conditions (e.g., severe weather, evacuation, post-disaster, etc.).
• Is involved in…