Billing Specialist (Palliative)

Hawaii Care Choices; Hilo (HI); On-site; USD 28,000 - 34,000; Full time

Job summary

Hawaii Care Choices is seeking a Billing & Coding Specialist for palliative care to manage claims submission, insurance verification, AR posting and denial follow-up. You will collaborate with the Intake and Accounting teams to ensure accurate pre-billing information and complete records.

Responsibilities include documentation review, compliance with HIPAA and payer policies, financial reporting, and patient account management.

Qualifications

• An associate’s degree in a related field.
• Two years palliative care billing experience preferred.
• Billing and/or coding certification preferred.
• Ability to use Excel and MS Office.
• Strong math and record-keeping skills.
• Knowledge of ICD-10, CPT, HCPCS and HIPAA.

Responsibilities

• Billing and Coding: Accurately process and submit palliative care claims to insurance companies, ensuring correct coding (ICD-10, CPT, HCPCS) and billing practices.
• Insurance Verification: Verify patient insurance coverage and benefits prior to services, ensuring eligibility for palliative care services.
• Claims Follow-Up: Monitor and follow up on denied or rejected claims, working to resolve issues and resubmit claims promptly.
• Patient Account Management: Manage patient accounts, including billing inquiries, payment processing, and addressing any discrepancies.
• Documentation Review: Ensure accurate and complete documentation for palliative care services, aligning with billing codes and regulations.
• Compliance: Maintain compliance with federal, state, and payer-specific regulations, including HIPAA, billing policies, and audit requirements.
• Financial Reporting: Prepare and submit regular financial reports detailing billing status, aging reports, and revenue cycle performance.
• Collaboration with Care Team: Communicate with healthcare providers and the care team to ensure proper documentation of palliative care services provided.
• Patient Advocacy: Assist patients and their families with understanding financial aspects of care, including payment options and insurance benefits.
• Training & Education: Stay up to date on billing codes, regulations, and industry trends, and provide guidance to staff on billing practices.
• Dispute Resolution: Resolve payment issues by negotiating with insurance companies, addressing underpayments, and identifying billing errors.

Skills

Self-motivated

Independent work

Math skills

Record keeping

Communication

Medical billing knowledge

Education

Associate degree

Tools

Excel

MS Office

Job description

Focus Areas

Palliative Care Billing & Coding | Insurance Verification & Claims Management | Accounts Receivable & Reconciliation | Regulatory Compliance | Collections

Position Summary

Primary responsibilities include patient care billing, accounts receivable posting and collections and follow up on claim denials. Works closely with the Intake team from point of admission to billing in capturing all pre-billing information to ensure billing success. Other duties include monthly accounts receivable reconciliation and reporting. This position also works closely and cooperatively with the accounting department to ensure complete and systematic set of records and related transactions are kept.

Essential Duties/Functions

• Billing and Coding: Accurately process and submit palliative care claims to insurance companies, ensuring correct coding (ICD-10, CPT, HCPCS) and billing practices.
• Insurance Verification: Verify patient insurance coverage and benefits prior to services, ensuring eligibility for palliative care services.
• Claims Follow-Up: Monitor and follow up on denied or rejected claims, working to resolve issues and resubmit claims promptly.
• Patient Account Management: Manage patient accounts, including billing inquiries, payment processing, and addressing any discrepancies.
• Documentation Review: Ensure accurate and complete documentation for palliative care services, aligning with billing codes and regulations.
• Compliance: Maintain compliance with federal, state, and payer-specific regulations, including HIPAA, billing policies, and audit requirements.
• Financial Reporting: Prepare and submit regular financial reports detailing billing status, aging reports, and revenue cycle performance.
• Collaboration with Care Team: Communicate with healthcare providers and the care team to ensure proper documentation of palliative care services provided.
• Patient Advocacy: Assist patients and their families with understanding financial aspects of care, including payment options and insurance benefits.
• Training & Education: Stay up to date on billing codes, regulations, and industry trends, and provide guidance to staff on billing practices.
• Dispute Resolution: Resolve payment issues by negotiating with insurance companies, addressing underpayments, and identifying billing errors.

Skills/Knowledge

• Competent working knowledge of Excel, MS Office tools and Windows.
• Self-motivated and able to work independently as well as in cooperation with others.
• Excellent mathematical and record keeping skills.
• Ability to use sound judgment in decision making and problem solve by utilizing resource materials and communication with others.
• Knowledge of the English rules of grammar, correct telephone etiquette, general office procedures, and filing.
• Knowledge and experience with medical billing processes.
• Knowledge and experience with general accounting principles.

Experience

• An associate’s degree in a related field from an accredited college or an equivalent combination of education and experience that demonstrates the ability to perform the essential functions of the position.
• Two (2) years Palliative care billing experience preferred.
• Billing and/or coding certification preferred.

Work Hours

• Primarily Monday through Friday, 8:00 am to 4:30 pm., with a half-hour meal break.
• May be required to work occasional weekend hours.
• Holidays observed.

Pay

$20.00 - $25.00/per hour

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.