Healthcare Reimbursement and Billing Specialist

Description of Work ***THIS A REPOST PREVIOUS APPLICANTS ARE STILL BEING CONSIDERED AND DO NOT NEED TO REAPPLY*** The purpose of this request is to justify the hiring of a Healthcare Reimbursement and Billing Specialist.
This position is critical to maintain the Healthcare Enterprise Accounts Receivable Billing and Tracking system and meet Federal and State Reporting Requirements for thirteen State Owned and Operated Healthcare Facilities.
Position is responsible for maintenance of complex inpatient and outpatient 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 numerous 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.
Verifying prior utilization and current available psychiatric benefits for Medicare Part A inpatients by using the Medicare proprietary system.
Submit CMS recognized electronic EDI X12 5010 837I, 837P transactions utilized for inpatient and outpatient billing practices through a Claims’ Clearing House and, paper formats (UB04 and CMS1500).
Healthcare claims compilation, validation of billing codes, billing and collections from Medicaid Managed Care Organizations, NC Tracks, Medicare and other third-party payers; ensuring appropriate authorizations received for services provided and billed.
Follow up on outstanding claims, submit adjustment claims as needed.
Analyze healthcare Medicare, NC Tracks, Medicaid and other third party payer Insurance Explanation of Benefits (EOB’s).
Audit patient accounts to determine validity of balance; take necessary action to correct any posting errors, request refunds, add/delete reported charges.
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.
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 23-13662 CONT 60037508 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: Work requires an intense level of mental concentration and a high degree of accuracy.
Working knowledge of electronic “inpatient” and “outpatient” Healthcare billing systems; “compiling” and submission of paper inpatient UB04 and outpatient CMS 1500 claim forms.
Experienced working with electronic healthcare claims for inpatient and outpatient services, and working with electronic remittance advices, 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 in 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 3 years direct experience in Healthcare third party billing (Commercial, Medicare and Medicaid) 3 years’ 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 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 three years of experience in accounting work; -OR- An equivalent combination of education and experience.
Supplemental and Contact Information The North Carolina Department of Health and Human Services (DHHS) is an Equal Opportunity Employer who embraces an Employment First philosophy which consists of complying with all federal laws, state laws and Executive Orders.
We are committed to reviewing requests for reasonable accommodation at any time during the hiring process or while on the job.
For more information about DHHS: https://www.
ncdhhs.
gov/.
DHHS uses the Merit-Based Recruitment and Selection Plan to fill positions subject to the State Human Resources Act with the most qualified individuals.
Hiring salary will be based on relevant qualifications, internal equity, and budgetary considerations pertinent to the advertised position.
It is critical to our screening and salary determination process that applications contain comprehensive information.
Information should be provided in the appropriate areas to include the beginning and ending dates of jobs worked, education with the date graduated, all work experience, and certificates / licenses.
Resumes will not be accepted in lieu of completing this application.
Answers to Supplemental Questions must refer to education or work experience listed on this application to receive credit.
Degrees must be received from appropriately accredited institutions.
Applicants seeking Veteran's Preference must attach a DD-214 Member-4 Form (Certificate of Release or Discharge from Active Duty) to their applications.
Applicants seeking National Guard Preference must attach a NGB 23A (RPAS) if they are a current member of the NC National Guard in good standing.
If a former member of the NC National Guard, who served for at least 6 years and was discharged under honorable conditions, they must attach either a DD256 or NGB 22.
If applicants earned college credit hours but did not complete a degree program, they must attach an unofficial transcript to each application to receive credit for this education.
Applicants may be subject to a criminal background check.
All candidates selected for positions considered "Positions of Trust" will be subject to a criminal background check.
Applications for positions requiring specific coursework must be accompanied by a copy of the applicant's transcript.
Applicants with degrees not conferred at a United States college or university must attach verification that their degree is equivalent to a similar degree from a U.
S.
institution.
The Office of State Human Resources uses the National Association of Credential Evaluation Services (NACES) as a referral resource for applicants who need to have their credentials certified as equivalent.
For a list of organizations that perform this specialized service, please visit the NACES membership website at https://www.
naces.
org/members.
Transcripts, degree evaluations and cover letters may be uploaded with your application.
NOTE: Applicants will be communicated with via email only for updates on the status of their application or any questions on their application.
If there are any questions about this posting other than your application status, please contact HR at 919-855-4930.
For technical issues with your application, please call the NeoGov Help Line at 877-204-4442.
If you have a technical issue with your Government Jobs account, please call their Help Line at 1-855-524-5627.