BILLING AND PRIOR AUTHORIZATION SPECIALIST
Horizon Health is a Critical Access, Rural Health Facility comprised of 25-inpatient beds located in Paris, IL & a multitude of outpatient clinic settings including Family Practice and Specialty Clinics in Paris and surrounding cities. We have been serving residents of Edgar County since 1968 though community education, emergency services, and outpatient care. As we continue to expand our services & locations, our community has grown far beyond Paris. Our rich history and strong community support pave the way for the future of healthcare as we serve you—our family, friends, and neighbors.
Position Summary:
Responsible for completing prior authorizations with insurance companies for Home Care services, submission of patient claims, assisting in clerical office duties, and other duties as assigned. Supports Home Care activities and departmental staff as needed.
Follows all policies and procedures established by Horizon Health and maintains confidentiality of departmental work.
Essential Functions:
- Implements efficient and timely prior authorizations for patient home care services.
- Completes billing and submission of claims.
- Ensures that patient accounts are maintained according to accepted accounting principles and in accordance with all state, federal, and accreditation standards.
- Monitors accounts receivables and resubmits bills as needed on overdue accounts and prepares reports for administrator regarding bad debt.
- Demonstrates knowledge of all payer contracts and follows specific requirements of the account when submitting claims.
- Reconciles Medicare reimbursement reports from the intermediary with the internal billing information systems.
- Maintains confidentiality of patient and agency information.
- Collaborates with clinical staff and supervisors to assure information required for accurate billing is received.
- Prepares, analyzes, and maintains financial and statistical reports.
- Adheres to established closing schedule and agency timelines.
- Maintains current and organized patient account filing system.
- Processes, posts, and reconciles payments received.
- Ensures effective communication and positive working relationships with personnel from all areas of the organization.
- Informs clinical and finance departments of any changes in coverage from payers or documentation needed to support reimbursement.
- Communicates necessary information to the supervisor and management team to ensure coordination of financial operations.
- Maintains contact with patients, payers, and other disciplines as needed to facilitate the reimbursement process.
- Identifies opportunities for operational improvements and participates in necessary data collection and evaluation. Initiates changes per findings.
- Performs chart audits or other audits for collection of information and shares relevant findings.
- Performs additional duties and responsibilities as deemed necessary.
The responsibilities listed above are not all-inclusive; other activities may be required in support of the hospital’s goals and objectives.
Position Requirements:
- Must possess excellent customer service, communication, and organizational skills.
- Proficient in Microsoft Office, including Excel, Word
- High School Diploma required, Associate Degree preferred in accounting or business
- Experience in health care billing and collections, preferably within home care
- Knowledge of billing regulations for Medicare, Medicaid, and insurance processing, medical terminology, and coding
- Ability to perform complex and varied tasks in a fast-paced work environment subject to stress and interruption
- Ability to establish priorities effectively and to be self-directed and capable of working without direct supervision
- High level of attention to detail and follow up of position responsibilities
Pay Range:
Pay ranges from $19.769/hour to $30.444/hour (rate of pay is based on applicable years of experience)
Horizon Health is committed to caring not only for our patients, but for our staff as well. We offer you an extensive total compensation and benefits package. As an employee of Horizon Health, your benefits include a competitive salary, medical, dental and vision insurance, Employee 403(b), health savings account with Company match, as well as Vacation, Sick and Paid Holidays.
Intrigued? Don’t wait, apply today. We are actively reviewing applicants for Home Care Billing & Prior Authorization Specialist role. Be part of an organization that is dedicated to the growth and development of its colleagues. Here at Horizon Health, our employees speak for themselves. Join our family & begin an incredible career!
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