Medical Billing/Accounts Receivable Specialist

Why a career with Independence First?

When you join Independence First you will be part of a
collaborative and passionate team. You will also enjoy lucrative
benefits! Independence First was selected as one of Milwaukee
Business Journal's Best Places to Work in 2022, 2023 and 2024.

Independence First is looking for awesome people to join our team!

You
are just the person to join our growing team if you are...

*Looking for an Excellent Benefits Package

*Passionate About Helping Others

Benefits include:

• 12 sick days, 13 vacation days and an additional 12 paid holidays
  a year
• Employer paid Dental, Life Insurance (twice annual salary),
  AD&D, Short and Long Term Disability
• Health Insurance Benefits (partially employer paid, depending on coverage)
• Low-cost Vision Insurance
• Employer-matched 403(b) Retirement Account
• Fitness Center On-site
• Annual Health Risk Assessment
• Annual Flu Shot
• Comprehensive Wellness Program
• Tuition Reimbursement Program

POSITION DESCRIPTION

I.
Position: Medical Billing/Accounts Receivable Specialist

II.
Status: Full Time, Hourly

III.
Reports to: Accounts Receivable Billing Supervisor

IV.
Position Summary:Submit insurance claims, work
denials, post insurance payments, file appeals when appropriate and
keep up to date on knowledge of current insurance reimbursement rates
and issues. Work in Sandata Software, clearinghouses, and payor portals.

V.
Position Expected Hours of Work: Typical hours are
full time 40 hours, Monday through Friday, 8:00AM through 4:30PM.

VI.
Essential Functions of the Position:

1. Perform timely follow up on insurance claim denials, exceptions or
   exclusions including unpaid or improperly paid claims within all
   contractual filing deadlines. Utilize aging accounts receivable
   reports to follow up on unpaid claims aged over 30 days by phone,
   mail, and/or electronic means.
2. Read and interpret payor explanations of benefits/explanations of
   payment, correctly identifying denials and improperly paid claims,
   and work claims accordingly. Provide detailed and accurate follow-up
   on assigned work
3. Maintain detailed functioning knowledge of our billing system.
   Utilize our internal billing software to sort, filter, summarize and
   identify various account receivable trends.
4. Work collaboratively with Accounting Clerk to ensure all claims
   are submitted with a goal of zero errors. This includes verifying
   completeness and accuracy of all claims prior to submission through
   Clearinghouse and working with Accounting Clerk to accurately post
   all insurance payments by line item.
5. Responsible for communication with billing sources,
   clearinghouses, and the PAS department to problem solve issues as
   well as as expedite claims management. In addition, responsible for
   the quarterly creation of a write-off report for aged receivables.
6. Participate on PAS Billing/Accounts Receivable Team Meetings.
   Communicate regularly with staff and management on any issues with
   reimbursement or billing.
7. Maintain an on-going knowledge of payor requirements as well as
   applicable contracts, regulations, and laws. Establish and maintain
   effective working relationships with carrier representatives.
8. Ability to support and take directions from multiple supervisors
   in the accounting department.
9. Document and track all work according to policy and procedure.
10. Responsible for a variety of tasks associated with the operation
    of the accounting department and Independence First as a whole.

I.
Work Environment:

1. Work environment is generally performed in an office setting with
   minimal to moderate noise level.

1. 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.

Disclaimer:

The above statements reflect the general details necessary to
describe the principle functions of the occupation described and
shall not be construed as a detailed description of all the work
requirements that may be inherent in the occupation.

I.
Professional Qualifications:

1. High School Diploma or equivalent.
2. At least five years experience working with Wisconsin Medicaid,
   insurance eligibility, medical billing, and prior authorizations required.
3. Have working knowledge of Sandata Software preferred.
4. Experience with Excel, various insurance portals, UB04 formatting,
   and HMO requirements and guidelines required.
5. Must be able to read and interpret insurance payor explanation of
   benefits and have experience in filing claim appeals with insurance
   companies to ensure maximum entitled reimbursement.
6. Excellent organization and interpersonal skills as well as
   excellent written and verbal communication skills required.
7. Strong analytical skills including ability to find errors and
   resole them, read, analyze, and interpret general business
   periodicals, professional journals, or government regulations.
8. Must be very detail oriented.
9. Ability to be flexible and multitask to meet the changing needs of
   the department.
10. Positive attitude and a team player.
11. Experience in HCPC, CPT and ICD-10 coding; familiarity with
    medical terminology.
12. Knowledge and ability to use computers. office equipment, and
    accounting software.
13. Competencies needed include ethical conduct, strategic thinking,
    leadership, decision making, communication proficiency, and public speaking.
14. Knowledge of Medicaid regulations in regards to the provision of
    Personal Care Services, as well as criteria for Medicaid Managed
    Care and Self Directed Supports, preferred.
15. Transportationally mobile or able to arrange own transportation.