Reimbursement Specialist (Remote) - 901 (Washington State Billing)

• THIS IS A FULLY REMOTE POSITION***
  
  

Telecare's mission is to deliver excellent and effective behavioral health services that engage individuals in recovering their health, hopes, and dreams. Telecare continues to advance cultural diversity, humility, equity, and inclusion at all levels of our organization by hiring mental health peers, BIPOC, LGBTQIA+, veterans, and all belief systems.

Position Summary

The Reimbursement Specialist is responsible for all billing and collection activities for assigned fee for service/third party facilities, including Medicare and Medi-Cal/Medicaid, counties, commercial insurance and members served. Keeps up to date on all applicable CPT and other coding changes, fee for service and/or contract billing rates and communicates those changes to all affected parties at Telecare. There may be some travel to locations where Telecare does business or plans to do business.

Full Time; AM 8:30 am - 5:00 pm; Monday - Friday

Expected starting wage range is $27.85 - $34.42. Telecare applies geographic differentials to its pay ranges. The pay range assigned to this role will be based on the geographic location from which the role is performed. Starting pay is commensurate with relevant experience above the minimum requirements.

Essential Functions

• Demonstrates the Telecare mission, purpose, values and beliefs in everyday language and contact with internal and external stakeholders
• Assists in developing the overall philosophy and objectives of accounts receivable services in accordance with the corporate mission
• Responsible for performing all of the billing and collection activities for assigned programs, ensuring timely and accurate billing, including:
• Confirming census, financial eligibility data, authorizations
• Completing paper and/or electronic billing to multiple payers
• Posting payments, manually and electronically
• Identifying under/overpayments and process refunds
• Responding to claim denials in a timely manner
• Running aging reports for collection call identification, completing collection calls and making follow up note entries
• Identifying bad debt and completing write off requests
• Identifying/completing billing adjustments
• Issuing client statements
• Completing month end reconciliation
• Collaborates with other management staff in strategic planning or development activities with the goal of ensuring ongoing effective billing and reimbursement
• Serves as active member of the Financial Review Committee, creating the agenda and leading the discussions about the pending receivables
• Promotes and maintains harmonious and effective relationships and communications within the department, with other departments, with government representatives and with customers
• Consistently updates knowledge of regulations, procedures and standards to assure compliance with contractual obligations and directives from governmental and regulatory agencies, fiscal intermediaries and contracting entities
• Manages all third-party denials and appeals, making certain that all appeals are completed on an accurate and timely basis
• Provides technical support and oversight of third-party reimbursement functions performed at the program level, especially for new programs
• Works with the Billing Manager to implement and maintain written policies and procedures so that the appropriate submission, billing and payment cycle of client accounts are maintained
• Actively participates in meeting customer needs and adapting to changing customer needs at all times
• Participates as a Revenue Cycle Department member and provides input via reporting observations, concerns and asking appropriate questions
• Appropriately applies rules and regulations in preparation of billings
• Follows proper internal controls
  
  

Duties and responsibilities may be added, deleted and/or changed at the discretion of management.

Qualifications

Required:

• Five (5) years of prior medical billing experience or two (2) years of college and one (1) year of healthcare experience.
• Extensive knowledge of Medicare, Medi-Cal/Medicaid and commercial insurances
• A high level of PC literacy, especially in Excel and Word
• The ability to operate independently, utilizing past extensive reimbursement experience and judgment
• This position requires the demonstrated capacity to work with sophisticated automated billing systems
• Applicant must be fingerprinted and receive clearance from the Department of Justice and The Office of inspector General
• Must be at least 18 years of age
• All opportunities at Telecare are contingent upon successful completion and receipt of acceptable results of the applicable post-offer physical examination, 2-step PPD test for tuberculosis, acceptable criminal background clearances, excluded party sanctions, and degree or license verification. If the position requires driving, valid driver’s license, a motor vehicle clearance and proof of auto insurance is required at time of employment and must be maintained throughout employment. Additional regulatory, contractual, or local requirements may apply.
  
  

Preferred

• Bachelor’s or AA degree
  
  

Skills

• High level of computer literacy
• Exceptional attention to details
• Other necessary skills include analytical and problem solving skills, the ability to understand complex reimbursement structures and governmental regulations and the ability to work and communicate effectively with program staff, management staff, government representatives and members served
  
  

PHYSICAL DEMANDS

The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

The employee is constantly required to sit and occasionally required to stand, walk, reach, twist, bend, pull and lift and carry items weighing 10 pounds or less as well as to do simple grasping occasionally. The position requires manual deviation, repetition and dexterity, occasionally drives. Visual requirements include computers and books exposure.

EOE AA M/F/V/Disability

If job posting references any sign-on bonus internal applicants and applicants employed with Telecare in the previous 12 months would not be eligible.