Medicare Billing and Collections Specialist

PruittHealth; Norcross (GA); On-site; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Medicare Billing and Collections Specialist to enhance their billing services. This role involves auditing, correcting, and submitting claims while ensuring timely and accurate billing processes. Successful candidates will thrive in a team-oriented environment, managing workloads efficiently and fostering continuous improvement. With a focus on problem-solving and account resolution, you will play a key role in maximizing reimbursement and maintaining positive relationships within the team. If you are passionate about making a difference in healthcare billing, this is the opportunity for you.

Qualifications

• 1-3 years of experience in medical billing and insurance claims.
• Familiarity with healthcare regulations and coding.

Responsibilities

• Perform billing and follow-up functions to secure reimbursement.
• Collaborate with facility administrators to manage accounts receivable.
• Research rejections and make corrections for timely billing.

Skills

Billing Documentation

Insurance Knowledge

Problem-Solving

Communication Skills

Data Entry Skills

Organizational Skills

Education

AA/AS in Accounting

Business Degree

Job description

Medicare Billing and Collections Specialist

Join to apply for the Medicare Billing and Collections Specialist role at PruittHealth.

Job Purpose

Supports the delivery of all insurance billing services by final/higher level auditing, correcting, and submitting claims. Ensures billing services are timely, accurate, and allow for appropriate reimbursement. Conducts follow-up on payment delays, takes corrective actions, and refers claims as needed to ensure proper reimbursement promptly. Handles month-end close and cash posting responsibilities across locations. Works within a team environment under general supervision.

Successful candidates manage a workload according to PruittHealth standards, are familiar with insurance billing rules, and excel in problem-solving and account resolution. They foster a team-oriented environment that values continuous process improvement, aligning with PruittHealth's high-performance culture.

Key Responsibilities

• Performs billing and follow-up functions, including investigating payment delays and pended claims to secure appropriate reimbursement efficiently.
• Collaborates with community facility administrators and office staff to manage accounts receivable.
• Edits claim forms, applying proper data instructions, and ensures correct coding and benefits coordination.
• Submits insurance claims, maintains bill holds, and corrects errors for timely billing.
• Researches rejections, makes corrections, and refers claims for resolution.
• Follows up on accounts, investigates delays, and maximizes reimbursement.
• Uses payer rules, contracts, and other data to research variances and correct claims.
• Resubmits claims, processes refunds, adjustments, and write-offs as needed.
• Responds to billing inquiries and issues, escalating when necessary.
• Participates in cross-training and team development, assisting in training peers.
• Plans and documents work to meet or exceed performance metrics and service goals.
• Adheres to policies, laws, and regulations, reporting violations appropriately.
• Contributes to process improvements and adapts to new systems and procedures.
• Maintains positive inter-team relationships and promotes a caring attitude consistent with PruittHealth's mission.

Knowledge, Skills, and Abilities

• Deep understanding of billing documentation, patient systems, and coding.
• Knowledge of insurance, governmental programs, and healthcare regulations.
• Familiarity with medical terminology and billing processes.
• Proficiency with healthcare billing, managed care, and data entry skills.
• Strong communication, problem-solving, and organizational skills.
• Ability to learn new systems quickly and work accurately under pressure.

Minimum Education and Experience

AA/AS in Accounting or Business preferred. 1-3 years of experience in medical billing, insurance claims, and patient accounting, including month-end closing and cash reconciliation.

Additional Information

Our family makes us stronger. We are committed to caring and making a difference. Apply now to start your journey with PruittHealth. We are an Equal Opportunity Employer, welcoming applicants regardless of race, color, religion, sex, national origin, disability, or veteran status.