We are looking for a Billing and Collection Specialist to work in our HOME OFFICE in Oldsmar.

This specialist is responsible for obtaining and managing accurate, timely completion of all authorization requests, along with billing, collections, and accounts receivable functions of the organization for assigned payor sources including insurance companies and Medicare.

ESSENTIAL JOB FUNCTION/RESPONSIBILITIES

• Billing of all payers are processed timely and accurately, daily.
• Daily collection activities for designated accounts, leading to the timely reimbursement of receivables using available resources including external/internal databases, payer portals/websites and telephone
• Take appropriate action to resolve denied/rejected invoices and preparation of payer corrections and/or appeals in accordance with payer plan requirements using electronic and paper processes
• Calculate expected reimbursement percentages based on contracted rates and properly notate accounts.
• Daily Review of EOPs/EOB/Ras/EOMBs for accuracy and patient responsibility.
• Reconciles and collects on assigned accounts.
• Identify trends, opportunities, and report data to direct supervisor same day.
• Meet productivity goals as assigned by the Billing/Reimbursement Manager. Work denials/rejections and take action to resolve to final payment. At least 50 managed care invoices per day and 75 episodical invoices per day.
• Utilize appropriate systems to actively contact Payers/Patients for account transactions.
• Ensures that all reconciled items and past due balances are resolved to completion through contact and follow-up with Payers/Patients.
• Communicates professionally with inter-company departments on resolution of potential disputed items.
• Responds to all inquiries with a resolution to concerns and or discrepancies.
• Participates in payer webinars and conference calls covering a wide range of topics that enables the Billing Team to effectively bill and collect accounts receivable.
• Assists in the training of all new A/R personnel when needed.
• Complies with HIPAA regulations on all accounts
• Protects the confidentiality of patient and organization information through effective controls and direct supervision of operations.
• Follows Pinnacle Home Cares Attendance Policy.
• Additional Duties/Tasks may apply as the business needs of the company evolve.

SKILLS REQUIRED

• Thorough understanding of episodic billing methodologies including PPS and PDGM.
• Analyzing and reconciling complex issues and problems timely.
• Constructively working when faced with high workloads and deadlines.
• Following directions and respectfully request clarification when needed.
• Identifying needs and opportunities and present them to the supervisor with recommended solutions.
• Working independently with minimal supervision.
• Preparing and analyzing appropriate reports and other business correspondence.
• Maintaining a positive outlook at all times.
• Communicating in a clear, precise, and hospitable manner
• Fostering two - way communication
• Addressing customer concerns in a courteous and timely manner
• Strong organizational and time management skills
• Use of relevant computer systems.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.