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Posted : Saturday, October 28, 2023 06:07 AM
Description of Work
Summary and Brief Description of Work:
This position is responsible for maintenance of complex inpatient healthcare accounts including a variety of accounting and patient records, determining appropriateness of all charges, payments, and adjustments maintained on specialized billing system, billing and collections from multiple third-party payors.
Specific job responsibilities include: Determining the appropriateness of all manual and system generated transactions (room and bed charges, payments and adjustments) that are maintained on the Affinity Healthcare Patient Accounts and Billing System.
Submit CMS recognized electronic EDI X12 5010 837I, 837P transactions utilized for inpatient billing practices through a claim clearing house and, paper formats (UB04 and CMS1500).
Healthcare claims compilation, billing and collections from Medicaid Managed Care Organizations, NC Tracks, and other third-party payers; verify integrity of claims by ensuring appropriate authorizations received for services provided.
Follow up on outstanding claims, submit adjustment claims as needed.
Analyze healthcare Medicare, NC Tracks, Medicaid, and Commercial Insurance Explanation of Benefits, using paper and EDI X12 5010 835I and 835P electronic formats.
Accurately report outstanding billable and uncollectible charges using system generated reports; compile comprehensive reports used in monthly receipt projection analysis.
Position interprets State and Federal policies and procedures as they apply to guarantor and third-party billing practices.
Position hours are 8:00 a.
m.
to 5:00 p.
m.
Monday through Friday.
Work requires an intense level of mental concentration and a high degree of accuracy.
Failure to successfully perform these duties could result in decertification by CMS and/or forfeiture of millions of dollars and have an adverse effect on the collection efforts of the CBO.
About NC Department of Health and Human Services: The North Carolina Department of Health and Human Services (DHHS) serves the needs of the most vulnerable of North Carolinians and to accomplish this, we hire only the most dedicated and caring individuals.
Finding qualified clinical professionals to treat and care for our clients is a continual challenge as demand for services grows and the availability of providers struggles to keep pace.
We are seeking a motivated individual who is up for this challenge and is dedicated to our mission of providing North Carolinians with the very best in clinical care.
About the DHHS Office of the Controller: The Office of the Controller sets and interprets all accounting and financial reporting policies and procedures for the Department as authorized by the rules and regulations of the Office of the State Controller and State Statute, and executes all accounting transactions for the Department of Health and Human Services.
Compensation & Benefits: The State of North Carolina offers excellent comprehensive benefits.
Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis).
Employees also receive paid vacation, sick, and community service leave.
In addition, paid parental leave is available to eligible employees.
Visit website for State Benefits 24-01665 CONT 60037514 Knowledge, Skills and Abilities / Competencies To receive credit for all of your work history and credentials, you must list the information on the application form.
Any information listed under the text resume section or on an attachment will not be considered for qualifying credit.
Qualified applicants must document on the application that they possess all of the following: Working knowledge of electronic “inpatient” and “outpatient” Healthcare billing systems; “compiling” and submission of paper inpatient UB04 and outpatient CMS 1500 claim forms.
Experience working with Version 005010 EDI X12 electronic healthcare transactions sets, including 837I, 837P, 835I and 835P and use of claims clearing houses.
Demonstrated experience billing healthcare patient accounts and collections including but not limited to Medicare, Medicare HMO, Medicaid Managed Care Organizations, NC Tracks and other commercial insurers, patients, and guarantors.
Working knowledge of Federal and NC General Statutes and Guarantor eligibility and reporting requirements.
Demonstrated knowledge of accounting, auditing inpatient and outpatient healthcare accounts, and cash management; A/R and A/P.
Demonstrated knowledge of Microsoft Office, proficiency in Excel.
Strong verbal and written communication skills and the ability to communicate with all aspects of the public.
Management Preferences: Proven working experience in healthcare accounting related field; A/R and A/P.
Three years direct experience in healthcare third party billing (Commercial, Medicare and Medicaid).
Three years of experience auditing Healthcare patient accounts; self-pay and third-party balances.
Working knowledge of Affinity Patient Accounting System.
Minimum Education and Experience Requirements Some state job postings say you can qualify by an “equivalent combination of education and experience.
” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both.
See oshr.
nc.
gov/experience-guide for details.
Associate's degree in Accounting from an appropriately accredited institution and two years of experience in accounting OR High school diploma or General Educational Development (GED) diploma and four years of experience in accounting work OR an equivalent combination of education and experience.
Supplemental and Contact Information
Specific job responsibilities include: Determining the appropriateness of all manual and system generated transactions (room and bed charges, payments and adjustments) that are maintained on the Affinity Healthcare Patient Accounts and Billing System.
Submit CMS recognized electronic EDI X12 5010 837I, 837P transactions utilized for inpatient billing practices through a claim clearing house and, paper formats (UB04 and CMS1500).
Healthcare claims compilation, billing and collections from Medicaid Managed Care Organizations, NC Tracks, and other third-party payers; verify integrity of claims by ensuring appropriate authorizations received for services provided.
Follow up on outstanding claims, submit adjustment claims as needed.
Analyze healthcare Medicare, NC Tracks, Medicaid, and Commercial Insurance Explanation of Benefits, using paper and EDI X12 5010 835I and 835P electronic formats.
Accurately report outstanding billable and uncollectible charges using system generated reports; compile comprehensive reports used in monthly receipt projection analysis.
Position interprets State and Federal policies and procedures as they apply to guarantor and third-party billing practices.
Position hours are 8:00 a.
m.
to 5:00 p.
m.
Monday through Friday.
Work requires an intense level of mental concentration and a high degree of accuracy.
Failure to successfully perform these duties could result in decertification by CMS and/or forfeiture of millions of dollars and have an adverse effect on the collection efforts of the CBO.
About NC Department of Health and Human Services: The North Carolina Department of Health and Human Services (DHHS) serves the needs of the most vulnerable of North Carolinians and to accomplish this, we hire only the most dedicated and caring individuals.
Finding qualified clinical professionals to treat and care for our clients is a continual challenge as demand for services grows and the availability of providers struggles to keep pace.
We are seeking a motivated individual who is up for this challenge and is dedicated to our mission of providing North Carolinians with the very best in clinical care.
About the DHHS Office of the Controller: The Office of the Controller sets and interprets all accounting and financial reporting policies and procedures for the Department as authorized by the rules and regulations of the Office of the State Controller and State Statute, and executes all accounting transactions for the Department of Health and Human Services.
Compensation & Benefits: The State of North Carolina offers excellent comprehensive benefits.
Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis).
Employees also receive paid vacation, sick, and community service leave.
In addition, paid parental leave is available to eligible employees.
Visit website for State Benefits 24-01665 CONT 60037514 Knowledge, Skills and Abilities / Competencies To receive credit for all of your work history and credentials, you must list the information on the application form.
Any information listed under the text resume section or on an attachment will not be considered for qualifying credit.
Qualified applicants must document on the application that they possess all of the following: Working knowledge of electronic “inpatient” and “outpatient” Healthcare billing systems; “compiling” and submission of paper inpatient UB04 and outpatient CMS 1500 claim forms.
Experience working with Version 005010 EDI X12 electronic healthcare transactions sets, including 837I, 837P, 835I and 835P and use of claims clearing houses.
Demonstrated experience billing healthcare patient accounts and collections including but not limited to Medicare, Medicare HMO, Medicaid Managed Care Organizations, NC Tracks and other commercial insurers, patients, and guarantors.
Working knowledge of Federal and NC General Statutes and Guarantor eligibility and reporting requirements.
Demonstrated knowledge of accounting, auditing inpatient and outpatient healthcare accounts, and cash management; A/R and A/P.
Demonstrated knowledge of Microsoft Office, proficiency in Excel.
Strong verbal and written communication skills and the ability to communicate with all aspects of the public.
Management Preferences: Proven working experience in healthcare accounting related field; A/R and A/P.
Three years direct experience in healthcare third party billing (Commercial, Medicare and Medicaid).
Three years of experience auditing Healthcare patient accounts; self-pay and third-party balances.
Working knowledge of Affinity Patient Accounting System.
Minimum Education and Experience Requirements Some state job postings say you can qualify by an “equivalent combination of education and experience.
” If that language appears below, then you may qualify through EITHER years of education OR years of directly related experience, OR a combination of both.
See oshr.
nc.
gov/experience-guide for details.
Associate's degree in Accounting from an appropriately accredited institution and two years of experience in accounting OR High school diploma or General Educational Development (GED) diploma and four years of experience in accounting work OR an equivalent combination of education and experience.
Supplemental and Contact Information
• Phone : NA
• Location : Wake County, NC
• Post ID: 9077750839
