HMO Biller @(PACS) Providence Administrative Consulting Services, Inc.

[Hiring] HMO Biller @(PACS) Providence Administrative Consulting Services, Inc.

Feb 23, 2025 - (PACS) Providence Administrative Consulting Services, Inc. is hiring a remote HMO Biller. 💸 Salary: unspecified. 📍Location: USA.

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Role Description

The HMO Billing and Collections Specialist is responsible for recording all revenue, electronic claim submissions, and timely collection from all HMO payer sources.

Monitors HMO claims by reviewing all HMO admissions, verifying eligibility, reviewing case management software, and ensuring payer and claim form is set up in patient records.
Ensures all billing and collections are pursued in a timely and effective manner for assigned centers, including researching, adjustments and rebills as needed.
Identifies reconsiderations, appeal opportunities, and collaborates and coordinates with facility staff to fulfill audit requests.
Completes HMO Triple Check with assigned centers to ensure UB-04 claim forms are correct and all revenue is accounted for and booked correctly.
Ensures HMO billing is submitted by the 5th business day and verifies receipt of claims by the 7th business day.
Follows PACS collections policy for all HMO payers and reports in a timely manner.
Documents all collection efforts in the patient billing record and healthcare software.
Partners with the Managed Care Department to maximize revenues.
Monitors and follows up on HMO claims by utilizing insurance platforms.
Acts as an insurance provider portal expert.
Ensures revenue is properly booked and billed by utilizing exclusion worksheets.
Research denials and over/under payments for all HMO claims.
Maintains in-depth knowledge of all HMO contracts and contract changes.
Provides education and communication to team members regarding HMO contracts.
Utilizes provider manuals, cheat sheets, managed care resources, and information sheets to ensure billing and collections are accurate and follow HMO contract requirements.
Monitors case management software for current authorizations, ongoing authorizations and communicate with center's leadership team when authorizations are outstanding.
Maintains constant communication with the centers Administrator, Business Office Manager (BOM), AR Resource.
Provides exemplary customer service and professional communication in all interactions with PACS team members, vendors, and outside representatives.
Develops and maintains a professional relationship with payer representatives to ensure timely collections.
Collaborates with Director of Accounts Receivable to champion department initiatives and special projects.
Performs other duties as assigned.

Qualifications

Minimum of 3 years' experience in a healthcare or accounting environment with an emphasis on HMO contracts, billing, and collections.
Knowledge of HMO contracts and Medicare/Medicaid regulations preferred.
Ability to creatively solve problems, be a team player, be well organized and flexible.
Experience in the development and training in accounting procedures and rules, and multi-site coverage an asset.
Must be proficient with Microsoft Excel, accounting software, and experiencing EHR and billing systems/software.

Education

Associate’s degree in business, accounting or finance or equivalent knowledge and skills obtained through a combination of education, training, and experience.

Supervisory Responsibilities

This position does have supervisory responsibilities.

Benefits

Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.
PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.
Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.
Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.
Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.

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📍	Be aware of the location restriction for this remote position: USA
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Back to Remote jobs > Finance / Legal

HMO Biller @(PACS) Providence Administrative Consulting Services, Inc.

Finance / Legal

Salary 💸 unspecified	Remote Location USA
Job Type full-time	Posted Feb 23, 2025

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📍	Be aware of the location restriction for this remote position: USA
‼	Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.

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[Hiring] HMO Biller @(PACS) Providence Administrative Consulting Services, Inc.

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