Nova Transformations is seeking to hire an experienced Billing and Utilization Review Manager
To support continued growth and maximize our revenues, we are creating a Revenue Cycle Management group. The ideal candidate to join this group will have expertise in third party billing and have experience in the substance abuse and mental health environments. In this role, you work closely with other departments and our facilities to ensure proper Billing and Coding.
Responsibilities:
Responsible for preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim submittals
- Responsible for reviewing, preparing and processing of patient statements
- Responsible for investigating denied claims from insurance companies and the re-processing of denied claims and/or submission of appeals of denied or underpaid claims
- Identify denial patterns, as well as provide a monthly report to upper management of payment delay issues and proactively plan solutions
- Responsible for billing insurance claims in a timely and accurate manner
- Responsible for identifying and billing secondary or tertiary insurances
- Contacts insurance companies and patients regarding outstanding accounts
- Answers all patient or insurance telephone inquires pertaining to the billing department
- Receives patient calls and resolves them in a professional manner. Meets/communicates with patients to resolve billing issues
- Reviews Accounts Receivable and Collection Write-Off Reports to determine and take appropriate action on accounts, i.e., set up payment plan or refer account to collection agency
- Must utilize critical thinking skills to determine if payer is in violation of contract terms or legal obligation to pay
- May be expected to research payments to patient accounts following appropriate payment posting procedures
- Submit patient statements on a routine, scheduled basis
- Follow-up on pay-to-patient insurance payments, ensuring facility receives payments
- Responsible for maintaining the highest level of billing standards following current guidelines from Medicare, Medicaid, and other insurance entities
Requirements:
- High school diploma or equivalent; higher education desired.
- Certified Professional Coder (CPC) or equivalent required.
- At least 2 years of experience with Third Party billing in the behavioral health and/or substance abuse setting.
- Expert level knowledge of, and willingness to comply with, laws and regulations affecting the work of a Biller.
- Full revenue cycle process experience required, including insurance verification, coding and claim submission, claim denial requisition, insurance payment posting and the appeals process
- Experience in using electronic health record software, (preferably KIPU) and electronic billing
- Must have experience with CollaborateMD
- Strong computer skills including average knowledge of Excel
- Exceptional communications skills – both written and verbal
- Ability to read, understand and use CPT, LCD and ICD 9/10 codes and adhere to Medicare guidelines and compliance
- Experience with common insurance payor portals
- Superior organizational skill, attention to detail, ability to work without micro-management
Job Type: Full-time
Pay: $60,000.00 - $70,000.00 per year
Benefits:
- Sick days
- Personal days
- Paid time off
Schedule:
- Day shift
- Monday to Friday
Experience:
- CollaborateMD: 2 years (Preferred)
- Substance Abuse Billing: 2 years (Required)
- Kipu: 2 years (Preferred)
Ability to Commute:
- Matthews NC 28173
Work Location: In person
Job Type: Full-time
Pay: From $65,000.00 per year
Benefits:
- Paid time off
- Tuition reimbursement
Experience:
- Utilization review: 2 years (Required)
License/Certification:
- Medical Billing Certification (Required)
Ability to Commute:
- Matthews, NC 28105 (Required)
Ability to Relocate:
- Matthews, NC 28105: Relocate before starting work (Required)
Work Location: In person
