Billing & AR Representative Job Listing at K12 Administration in United States of America (Job ID 295714)

Description

JOB DESCRIPTION    Division:                            Community Autism Services (CAS) Department:                    Revenue Cycle Operations Job Title:                           Insurance Team - Billing and AR Representative Reports to:                       Insurance Billing Supervisor Effective Date:                 December 2024 Position Status:               Non-Exempt    What Does Success Look Like   At The Stepping Stones Group, we believe in transparency about the expectations of each team member. In joining our team as an Insurance Team - Billing and AR Representative, the following are the outcomes that our team and individual team members are working to achieve daily.  

1. Submit 100% of claims for two weeks within each billing week with zero claim rejections
2. Maintain zero denials in work queue and identify trends to prevent subsequent denials
3. Take proactive action on >90% of outstanding balances aged <90 days with no denial on record or unclear denial

  We believe that visibility and diligence ensure our team and team members maintain a sharp focus on achieving these outcomes. To best support each team members success in their roles, each team member participates in a daily team huddle where the measures are reviewed and support is provided.   Team Culture - Our Behaviors Define Us   We are looking for someone specific! In our division, we strongly believe that our behaviors define us. These behaviors are at the forefront of the culture that we build within our team, department, and division, and serve as the foundation for our annual performance review discussions.     Behaviors and Definitions Team First Inspires and motivates self and others Willingly shares opinions and ideas, even if they don't align with group consensus Engages and involves self and others Manages time effectively Make a Difference Understands and consistently meets individual and team objectives Proactively manages work processes Focuses on what's most important (80/20) Delivers high quality outcomes (clinical or operational) See it Through Understands and consistently meets individual and team objectives Achieves expert status (on your work, in your lane) Generates critical insights, drives to decision and aligns to actions Produces and delivers creative and pragmatic solutions Be Yourself Understands self and impact on others Builds strong, collaborative, trusting relationships Participates and presents effectively Demonstrates openness to new approaches Better Every Day Demonstrates a can-do attitude, even in the face of difficult problems Learns from mistakes and does not repeat them Is constantly looking for ways to improve Provides appropriate and reacts positively to feedback     Essential Job Functions  

• Review and scrub billing records for insurance clients, ensuring that payer guidelines are met prior to generating a claim for submission
• Generate claims for claim submission, ensuring that claims are generated in adherence with payer guidelines
• Correct all claim errors that are flagged by the practice management system and release claims to the clearinghouse in a timely manner
• Review and correct all claims that reject by the clearinghouse or the payer, ensuring that feedback is looped back to prevent repeat rejections from occurring if there are trends identified
• Work all denials in the clearinghouse that are tied to your billing submissions, ensuring that trends are communicated to appropriate teams and denials aren't aging out past 90 days
• Review total AR for assigned offices to ensure that payers who aren't processed via the clearinghouse are being actioned on in a timely manner
• Other duties as assigned.

  Minimum Job Requirements 

• Behavioral health claims billing and denial management experience. ABA-specific billing experience highly preferred
• Experience billing within a practice management system. Central Reach experience preferred
• Experience working within insurance payer guidelines
• Experience working within a clearinghouse. Waystar/Zirmed experience preferred
• Experience working in a fast paced, target-driven environment
• Experience aggregating data to report and communicate trends
• Experience calling out to payers to obtain information on billing submissions or denials
• Experience navigating payer portals
• Experience partnering internally, with both clinical and non-clinical teams
• Experience with Microsoft Office products
• Ability to multitask and maintain a strong work ethic
• Self-motivated, proactive, independent, and detail-oriented

  Physical Requirements

1. Repetitive motions
   1. Movements frequently and regularly required using the wrists, hands, and/or fingers
2. Visual abilities
   1. Average visual acuity necessary to prepare or inspect documents or products, or operate machinery, including personal computer
3. Hearing
   1. Able to hear average or normal conversation
4. Physical Strength
   1. Sedentary work; sitting most of the time
   2. Exerts up to 10 pounds of force occasionally
       
       

 Apply on company website