Professional Billing Specialist, Anesthesia

This is a fully remote position, open to applicants in United States.

📋 Description

• Overseeing all professional billing obligations.

• Managing accounts receivable functions in line with standards and productivity metrics.

• Ensuring compliance with all regulatory and payer guidelines.

• Coordinating activities related to payer denials and appeals to secure prompt responses from third-party payers.

• Handling all payer denials, documentation requests, and appeals processing.

• Assessing all denial accounts for categorization and specific requirements needed for initiating appeals.

• Communicating overarching payer issues with the payer relations team.

• Assisting in the oversight of daily operations concerning appeals follow-up and denials.

• Maintaining the healthcare tracking tool/application.

• Supervising all Claim Edit and Denial Management work queues and lists.

• Ensuring that medical records requests are fulfilled and submitted within a 48-hour timeframe.

• Monitoring all denials in a database to analyze outcomes.

• Collecting and analyzing data, reporting status, metrics, and trends of activities.

• Distributing reports regularly to a designated distribution group.

• Organizing all data and activities in a manner that is easily retrievable.

⛳️ Requirements

• Experience with Epic PB Resolute.

• A minimum of 3 years of relevant Anesthesia experience.

• At least 5 years of experience in a Healthcare/Hospital Revenue Cycle Environment, including Third Party Collection/Accounts Receivable.

• Knowledge in Healthcare Revenue Cycle revenue management.

• Familiarity with EDI Transaction sets, including 837P.

• Understanding of insurance contract rates and terms.

• Knowledge of Registration and Collections processes.

• Awareness of Government and Managed Care billing, coverage, and payment regulations.

• Ability to interpret payer 835 and paper EOB responses.

• Understanding of CCI edits, CPT, HCPCS, ICD-10, and Revenue Codes.

• Intermediate proficiency in Excel.

• Strong computer skills, particularly in spreadsheet and database applications.

• Knowledge of managed care patient financial systems and the specific billing and payment standards used for services in a hospital environment.

• Comprehensive knowledge of managed care payment methodologies and principles.

• Certification in Epic PB Resolute or willingness to obtain certification within 12 months of hire.

• Bachelor’s Degree or a comparable mix of education and experience.

🏝️ Benefits

• All employees are eligible for medical coverage from their first day!

• Eligibility for a 403(b) and Roth 403(b) Retirement Savings Plan with matching contributions of up to 6% after one year of service.

• Paid time off.

• Life insurance.

• Short-term and long-term disability coverage.

• Flexible Spending Account (FSA) plans.

• Health Savings Account (HSA) available if a High Deductible Health Plan (HDHP) is chosen.

• Additional perks include tuition reimbursement.

• Home and auto insurance options.

• Hospitalization coverage.

• Critical illness insurance.

• Pet insurance.

• Coverage for employees and dependents as per the plans.