LTC MANAGED CARE BILLING SPECIALIST (70980)

Priority Management; Dallas (TX); On-site; USD 40,000 - 60,000; Full time

Job summary

Priority Management is hiring a Long Term Care Managed Care Billing Specialist in Dallas, TX, to join an established team of professionals. The role involves accurate submission and follow-up on claims, ensuring compliance and maximum reimbursement.

The ideal candidate will have a high school diploma with at least 2 years of medical billing experience, strong problem-solving skills, and proficiency with billing software and Microsoft Office. The position is crucial for maintaining service excellence and compliance.

Qualifications

• 2+ years of experience in medical billing and collections.
• Exceptional problem-solving abilities related to claims.
• Knowledge of HIPAA compliance and requirements.

Responsibilities

• Prepare and transmit electronic claims accurately.
• Verify insurance coverage for claim accuracy.
• Identify secondary and tertiary payers as needed.
• Review and apply payments against related accounts.
• Communicate with BOMs and RAMs to resolve claims.

Skills

Analytical skills

Problem solving

Customer service

Time management

Detail orientation

Education

High School diploma or general education degree

Tools

Microsoft Office Suite

Billing software

Texas Medicaid

Job description

Job Location: BRIDGEPOINTE FINANCIAL SRVICES - DALLAS, TX 75219

Job Shift: Day

Position summary: Immediately hiring Long Term Care Managed Care Billing Specialist to join an established team of exceptional and dedicated professionals at our Central Billing Office (CBO).

Job Overview

This Managed Care Billing Specialist will be responsible for the timely and accurate submission of claims ensuring those claims result in maximum reimbursement. The position will interact with and provide consistent and exceptional customer service to Business Office Managers (BOMs) and Regional Account Managers (RAMs) while having discussions based upon data used to prevent and/or resolve claim issues. They must ensure compliance in record keeping and honor calendar deadlines to achieve billing and financial close goals. This position requires prompt follow up on open items to ensure full payment received on behalf of the Residents being served.

Job Responsibilities & Duties

• Preparing, reviewing and transmitting electronic claims using our billing software and clearinghouse, and paper claims as necessary.
• Verify insurance coverage as needed to confirm accurate claim submission.
• Identify secondary and tertiary payers as needed.
• Ensure clean claims released to insurers and follow up on unreleased claims within billing cycle timeframes for multiple locations.
• Review payments for accuracy and apply those payments against the related account.
• Coordinate with BOMs to investigate and resolve denied claims and return corrected claims to the appropriate insurer promptly.
• Work with representatives of insurance companies (including Medicare and Medicaid) to resolve payment discrepancies.
• Possess strong analytical, time management, organizational, problem solving and decision-making skills.
• Comfortable communicating with all levels of finance, admissions, medical records, and clinical representatives.
• Must have a working knowledge of Medicare, Medicaid and be familiar with commercial insurance billing and their respective plans.
• Provide exceptional customer service.
• Strong computer and billing software skills.

Communication & Cognitive Abilities

• Cooperate with team members to meet goals and complete tasks.
• Exceptional communication and interpersonal skills.
• Must be comfortable working in stressful and deadline driven environment.
• Must be self‑motivated, possess good judgement and know when to seek guidance.
• Detail orientation is essential.
• Flexibility to change priorities quickly and have the capacity to handle multiple tasks.
• Willingness to work independently, but also harmoniously as a part of the CBO team, and a larger geographically disbursed team with the BOMs and RAMs.
• Must be knowledgeable of HIPAA compliance and requirements.
• Keep up to date on technology trends, developments and best practices.

Qualifications

• High School diploma or general education degree.
• 2+ years of experience in one or more aspects of the medical billing & collections cycle.
• Exceptional problem-solving abilities and attention to detail particularly as it relates to claim investigation, denials, appeals and collections.
• Knowledge of Microsoft Office Suite.
• Knowledge of Texas Medicaid, PCC and/or American Health Tech software packages are a plus.
• Managed Care Insurance Portals.
• Review/Communicate Trends and Resolutions.