[Hiring] Accounts Revenue Specialist @Active Day

Role Description

The Accounts Revenue Specialist is responsible for the accurate and timely billing of services provided to adult day care participants. This role ensures claims are submitted in accordance with Medicaid, managed care organizations, and other payer guidelines while maintaining compliance with state and federal regulations. The Adult Day Care Biller collaborates closely with center leadership, regional directors, intake staff, and clinical teams to ensure all billable services are properly authorized, documented, and reimbursed.

Qualifications

• High school diploma or equivalent; Bachelor's or Associate’s Degree in an Accounting field and/or minimum 1 year prior experience in Revenue Cycle role strongly preferred.
• Prior working knowledge and experience with medical EHR/billing systems strongly preferred.
• Strong Excel skills required (ability to sort, filter, pivot, and organize large sets of data).
• Strong MS Word and Outlook skills.
• Extremely strong analytical and mathematical skills.
• Knowledge of CPT-4/HCPC, ICD-10-CMJ, Revenue Codes and DRGs required.
• Knowledge of UB-04 and HCFA 1500 bill forms DRGs strongly preferred.
• Familiar with third party billing practices, contracts and regulations including but not limited to Managed Care Organizations and government payers strongly preferred.
• Must have very strong problem-solving skills as well as a strong attention to detail.
• Strong written, verbal communication and relationship building skills.
• Able to multi-task, meet tight deadlines while managing time effectively.
• Ability to work on electronic payer portals to perform applicable job duties.

Requirements

• Resolve collections by examining and validating submitted claims, rebilling and correcting denied claims on the provider portals to ensure that payer issues reimbursement for service(s) provided.
• Resolve billing discrepancies; follow up on outstanding claims by reviewing, investigating and reprocessing denied claims.
• Collaborate with the agency and management on identifying payer issues and trends affecting the outstanding accounts receivable.
• Become the go-to expert on assigned payers, including knowledge of state Medicaid regulations, such as timely filing, contacts, contracted rates and develop contacts to help resolve issues.
• Submit appeals for denied claims as appropriate.
• Correct system billing transactions when applicable claim resolution requires it.
• Verify validity of account discrepancies by obtaining and investigating information from various sources.
• Prepare reports and include status of collection efforts.
• Accomplish accounting and organization mission by completing related results as needed and always look for ways to assist and improve.
• Update receivables by accurately totaling unpaid invoices.
• Other duties and responsibilities as changed or assigned at any time.

Benefits

• Paid Time Off (“PTO”)
• Medical/Vision
• Dental
• 401(k)
• Employee Assistance Plan