Billing Specialist I and II - Senior Living Organization at The Carmelite System, Inc.

Holyoke, Massachusetts, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Oct, 26

Salary

31.25

Posted On

12 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medicare Billing, Medicaid Billing, Managed Care Networks, Insurance Carriers, Accounts Receivable, CPT Coding, ICD-10 Coding, HIPAA Compliance, OSHA Regulations, Medical Terminology, Mathematical Skills, Point Click Care, Claims Processing, Payment Posting, Denial Management, Triple Check Reviews

Industry

Hospitals and Health Care

Description

Billing Specialist The Carmelite System is a multi-state, not-for-profit senior living organization sponsored by the Carmelite Sisters for the Aged & Infirm operating a network of Skilled Nursing Facilities and Assisted Living/Independent Living communities. We are seeking to hire a Billing Specialist I and a Billing Specialist II. * This corporate level position is fully remote. Current Team members work in Eastern and Central Standard Time. * Billing Specialist I = $16 per hour to $26.44 per hour based on skills and experience. * Billing Specialist II = $27 per hour to $31.25 per hour based on skills and experience. Billing Specialist Qualifications: * High School diploma or equivalent. * Extensive knowledge of Medicare, Medicaid, managed care networks and insurance carriers required. * Extensive knowledge of accounts receivable functions including CPT and ICD-10 coding required. * Solid understanding of the current Medicare Compliance, OSHA, and HIPAA regulations and medical terminology required. * Strong basic mathematical skills required. * Understanding of Medicaid, Medicare, and Third Party Billing preferred. * Billing Specialist II = 2+ years experience of skilled nursing facility billing and 2+ years experience using PCC (Point Click Care). Billing Specialist Job Summary: * Prepare, review, and transmit claims using billing software. * Analyze explanation of benefits forms to review denial codes and make appropriate corrections. * Follow up on balances, unpaid claims, appeals & denials within the set timeframe. * Post payments and adjustments to accounts and maintain backup records. * Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Ensure proper records handling. * Input ancillary charges into the billing software in accordance with protocol. * File all charge, payment, adjustment batches, refund requests and write off requests in the appropriate format and location (PCC and shared drive). * Prepare and review claims for billing prior to triple check. * Attend and lead monthly triple check reviews. * Follow claims process from submission to clearinghouse and ensure acceptance at payer. * Process refunds to insurance companies in accordance with policy. * Monitor reimbursement from managed care networks and insurance carriers. This is a brief overview of job responsibilities and not intended to be all inclusive. We aim to create a supportive workplace where you are valued, compensated fairly and provided the tools to thrive! The Carmelite System Can Offer You: * Competitive Compensation * Health (Aetna), Dental, Vision, HSA with employer contribution * Flexible Spending Account * Fully paid Life and Long-Term Disability insurance * Benefits available 1st of the mo. following 30 days * Supplemental insurances * Retirement Plan * Student Loan Forgiveness Guidance * Employee Assistance Program with Discount Marketplace * Generous Paid-Time-Off with 11 Holidays Please consider joining our team working where The Difference is Love℠! The Carmelite System, Inc. is an Equal Opportunity Employer and adheres to a policy that prohibits discrimination on the basis of race, color, sex, sexual orientation, gender identity, religion, creed, national or ethnic origin, citizenship status, age, disability, veteran status, and any other legally protected class. #CS2024

Responsibilities

Prepare and transmit insurance claims while analyzing explanation of benefits to resolve denials and unpaid balances. Maintain patient confidentiality and manage payment postings, adjustments, and ancillary charges within the billing software.