Title: Intake/Billing Specialist

 

About the Position

We are currently seeking a Billing Specialist to join our team. We are searching for a technologically savvy individual to ensure the efficient day-to-day operation of the office and support the work of management and clinical staff. This is a full-time position offering approximately 40 hours per week in a flexible and relaxed environment. Heavy focus on telephonic communication, data entry and claims processing; therefore must have experience with databases and be proficient with Google and Microsoft Office Applications.

 

Primary duties include but are not limited to:
  • Respond to telephonic and email inquiries from clients, providers and payers

  • Independently review and evaluate routine and complex electronic and paper claims (HCFA-1500, UB04).

  • Determine if services rendered on the claim are allowable under the member’s benefit plan and/or the proper authorization, referrals and pre-registrations were obtained as required by the plan.

  • Examine claim to correct and/or update data so claim can properly adjudicate.

  • Determine appropriateness of reported services.

  • Identify and resolve issues in a timely manner regarding claim processing.

  • Prepare and send monthly statements to clients

  • Post insurance and client payments to appropriate accounts

  • Research and resolve discrepancies for unpaid or denied claims

  • Establish relationships and communication with clients and customers.

  • Communicate with partner departments (verbally and/or written) to obtain missing information to properly adjudicate claims, such as provider numbers, authorizations and referrals.

  • Coordinate with health plans to verify insurance coverage and plan limitations.

  • Assure claims are submitted to the appropriate parties for payment.

  • Educate clients on their benefit coverage and financial responsibility.

  • Attend monthly meetings with owners and staff

  • Provide additional support to administrative and clinical staff as assigned.

 

Quality and Production:
  • Achieve individual standards for quality and production as assigned by supervisor.

  • Contribute to team and departmental standards for quality and production.

  • Monitor pending claims and adjustments daily and ensure claims are released timely for adjudication.

  • Participate in identifying opportunities for overall process improvements.

  • Comply with all department and company guidelines and policies.

Minimum Qualifications

Education: High School Diploma, Associates degree or equivalent business experience in a claims/customer service healthcare environment preferred.

Experience: At least 1 year of experience in claims processing and insurance verification, or any combination of education and experience, which would provide an equivalent background required.

  • Must have in-depth knowledge of Managed Care concepts and a strong understanding of CPT, ICD-10 (ICD-9), HCPCS coding guidelines and CMS1500

  • & UB04 billing formsMust have understanding of Explanation of Benefits and primary/secondary insurance principles.

Must have thorough understanding of insurance terminology and plan structures.

Must have strong analytical and decision making skills in order to make accurate claim processing determinations with minimal supervisory intervention.

 

Knowledge, Skills & Abilities:

  • Excellent communication skills & analytical thinking skills

  • Excellent task facilitation, organization and prioritization skills

  • Computer application proficiency

  • Customer service skills

  • Strong attention to detail

  • Ability to thrive in a fast-paced work environment and multi-task

  • Ability to work independently as well as part of a team

  • Highly capable of performing repetitive tasks with excellence

 

Position Details

This is a full-time forty (40) hour position based in Plymouth Meeting, PA. The position’s schedule is a Monday through Friday work week.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at ETHOS is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

ETHOS is an Equal Opportunity Employer and qualified applicants will not be discriminated against on the basis of race, color, religion, gender, national origin, disability or veteran status.

To Apply please submit resume to jobs@ethostreatment.com