- Must be able to interpret payer explanation of benefits (EOBs) to ensure proper reimbursement of claims and report any problems or payer trends to management.
- Work with payers and necessary web portals to determine reasons for front end rejections/edits, correct and resubmit claims for reimbursement within timeframes established by management
- Understand terminated insurance issues and have the ability to initiate billings to a new payer or bill patient accordingly.
- Remain up to date on payer informational notices and changes.
- Knowledge of specialty billing services, such as Advance Wound Care and Negative Pressure Wound Therapy.
- Knowledge of Modifiers used for Advance Wound Care and Negative Pressure Wound Therapy specialty billing services.
- Ability to work in a fast pace and high-volume environment.
- Identify and communicate ideas for process improvements.
- Comply with all work instructions, policies, and behavioral expectations.
- Assist with month-end processes as needed.
- Complete projects as assigned.
- Provide guidance to staff in manager's absence as needed.
- Associate Degree or equivalent preferred; minimum two years related experience; or equivalent combination of education and experience
- Demonstrated organizational skills with strong attention to detail
- Proven troubleshooting skills
- Proficient with Microsoft Word, Excel, Outlook
- Ability to learn revenue cycle related IT systems and functions
- Solid understanding of insurance payers and guidelines including but not limited to Blue Cross, Medicare, Medicaid, Workers Compensation, and all Commercial managed-care plans
- Ability to handle inquiries and respond via telephone or in writing
- Proper use of ICD-10 and HCPCS codes
- Knowledge of medical terminology and coding
- Ability to independently meet stringent deadlines in a project-based atmosphere.
- 5-10 years of wound care billing processes and/or other specialty billing processes
- Strong work ethic and sound judgement
- Proven written and verbal communication skills
- Natural curiosity to pursue and resolve issues and increase expertise
- Passionate about InfuSystem and serving customers and patients
- Strives to make an impact on improving our business processes and results
- Exemplary honesty and integrity
- Ability to collaborate effectively and work selflessly as part of a team
- Health plan options that include an employer contribution
- Health Savings Account (HSA)
- Healthcare and Dependent Care Flexible Spending Accounts (FSA)
- Dental and Vision premiums covered by InfuSystem
- Life Insurance, STD & LTD
- Paid Parental Leave
- Adoption and Fertility Assistance
- 401(k) with a specified Company Match
- Employee Stock Purchase Program
- Tuition Assistance
- Generous Paid Time Off plan
- Employee Assistance Program
- Competitive Pay
- Employee Referral Bonus
- Spot Bonus Program
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RCM Sr. Wound Billing Specialist - Rochester, United States - InfuSystem
Description
InfuSystem is a growing healthcare service provider, specializing in infusion pumps and related products and services for patients in hospitals, clinics, ambulatory surgery centers, and other major service centers. We provide direct payer rentals, pump and consumable sales, and biomedical services and repair, serving all 50 states and Canada. Headquartered in Rochester Hills, Michigan, we have Centers of Excellence in Kansas, California, Massachusetts, Texas and Ontario, Canada.
As a leader in our field, our mission is to provide quality infusion services to patientsand medical practices, including a 24-hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of ourpatients and the communities we serve. Service is always our highest priority; keeping the patients' health & safety at the center of everything we do.
SUMMARY:
The Revenue Cycle Wound Billing Specialist is responsible for the management of activities related to third party payer billing. This can include but is not limited to, identifying and logging authorizations from payers, timely and accurate filing of claim submission and working any claim related edits. Claims must be billed adhering to all federal and state requirements in addition to meeting payer requirements. The individual in this position will have demonstrated proficiency in billing a variety of payers and wound care service lines. Quality and productivity scores must be above average. This individual will also act as a knowledge source for the department. This is a hybrid opportunity.
IN THIS ROLE, THE IDEAL CANDIDATE WILL:
Team members will be responsible for achieving established productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.
SUPERVISORY RESPONSIBILITIES:
This position has no supervisory responsibilities
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:
The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPREHENSIVE BENEFIT PACKAGE:
At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work
