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Billing and Collections Associate

Secaucus, New Jersey
KJM Staffing Solutions currently has several great Temp to Perm opportunities for Billing and Collections Associates with our client, a large and prestigious healthcare solutions provider.  The roles will be based at the Secaucus, NJ location and the successful candidate will have at least 1-2 years of hospital billing experience (EPIC) is strongly desired.  We are seeking team players who are open to professional growth within a leading healthcare company.  Candidates will convert to full-time direct hire employees of client within 6-months.  This role offers a great environment and excellent benefits and growth potential.  These positions are full-time and on-site.  Base is up to $19/hr dependent upon experience.

Responsibilities 
  • Review accounts to determine appropriate follow-up action
  • Access client’s system to obtain needed information to resolve claims
  • Investigate and resolve claims denied due to coverage issues, medical record requests and authorizations
  • File appeals on claim denials
  • Pull medical records out of EPIC System
  • Accurate and timely claims follow-up by assigned payer/s and defined aging criteria to meet or exceed collection targets and minimize timely filing write-offs.
  • Performs eligibility and claim status follow-up inquiries utilizing outbound calls to the payer, web link tools and payer websites.
  • Effectively documents claim status and next steps in the Practice Management System (PMS) to expedite timely and accurate claims processing. Meets or exceeds established performance targets (productivity and quality) established by the Accounts Receivable (A/R) Supervisor.
  • Accurate and timely research of claim denials by assigned payer/s. Works with payer to determine reasons for denials; corrects and reprocesses claims for payment in a timely manner. Proceeds with appeals process as needed. Meets or exceeds established performance targets (productivity and quality) established by the A/R Supervisor.
  • Identifies root causes and denial trends and works with the payer Customer Service Department to reprocess claims for payment. Escalates, as needed, to the Accounts Receivable (A/R) Supervisor to address at the payer Provider Representative level as needed.
  • Performs accurate and timely write-offs (e.g. no authorization) following identification of uncollectible accounts adhering to IPM CBO policy guidelines.
  • Participates in regularly scheduled team meetings sharing denial trends specific to claim requirements to enhance front end claim edits to facilitate first pass resolution. Contributes ideas for work flows and approaches to A/R follow-up tasks to maximize opportunities for performance, process and net revenue collections improvement.
  • Effectively prioritize work assignment/s and demonstrate flexibility in assuming payer specific A/R claim follow-up and denial management assigned to another A/R Specialist to ensure the team is meeting or exceeding department goals.
 
Qualifications
  • High school diploma or equivalent
  • A minimum of 2 years of experience in a healthcare setting with 1-2 years of billing experience in a facility and hospital setting.
  • Medical billing experience working with explanation of benefits (EOBs)
  • Extensive and current working knowledge of government, managed care and commercial insurances claim submission requirements, reimbursement guidelines, and denial reason codes.
  • Experience and working knowledge of UB-04 claim forms.
  • Experience with patient billing editor systems.
  • Understanding of the entire revenue cycle process.
  • Knowledge of Revenue and ICD coding language.
  • Knowledge of Managed Care, Medicare and Medicaid billing regulations, HIPAA
  • Works well in a fast paced environment
  • Preferred knowledge in hospital patient accounting systems, EPIC desired.
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