PLAZAS Y OPORTUNIDADES DISPONIBLES

Who we are?

We are the authorized distributor of the Diabetes medical equipment Dexcom (Continuous Glucose Monitor) and Tandem (Insulin Pumps) in Puerto Rico and the Caribbean.

Overview:

The Billing and Collections Analyst is responsible to receive the case once DME delivery is completed in order to start and complete the process of billing, collections, cash posting and reconciliation. Is also responsible for maintaining the Revenue Cycle Manager up-to-date of any situation that affects the cash flow and visits insurance carriers for outstanding claims.

Billing & Collections Analyst .:::. Job responsibilities

On Proclaim (company’s billing system) review information in patient accounts and enter patient demographic and insurance information as needed.

Utilize available resources to gather complete insurance data including use of insurance websites.

Before creating a claim on the billing system, review that all billing required documents are attached to CRM or OPEI, CPT, Dxs. and any other information that it’s mandatory to bill charges.

Complete insurance verifications as needed.

Ensures all charges are initially submitted within 4 business days of the date of service, according to Medicare and Medicaid regulations and received by payers.

Ensures to create the opportunity for and service estimate during the closing stage process in the CRM.

Bill charges to patients when necessary.

Monthly, review and analyze the A/R Aging; and conduct audits of balances pending.

Processes billing weekly; notify Revenue Cycle Manager when errors occur that prevents complying with the deadlines.

Analyze and resolve insurance denials by examining the provider documentation, according to the payer’s timeframe and procedures; notify Revenue Cycle Manager of any recurring issues and patterns that lead to the volume of denials.

Prepare various billing reports as assigned and inform any issues back to the Revenue Cycle Manager.

Handles escalated or complex claims according to payers’ appeals levels.

Respond to escalated billing inquiries from patients, insureds and internal staff.

Apply into the billing system all electronic and manual payments within the month it is received.

Process write-offs, credit memos, other billing adjustments, return premium disbursements (refunds), process select cash application transactions including payment reversals, payment transfers, and modify payment distribution.

Record claims deductible charges and maintain automatic payment set-ups.

Weekly, visits the payers to discuss any issues that result in denials.

Maintains excellent communication with the medical office, patients and payers’ representatives.

Work closely with all internal areas to assure a proper process.

Meet production metrics and daily workflow.

Other duties and responsibilities as assigned.

Requirements:

A certification in Billing for Medical Plans is required and or a Medical Assistant course, preferred.

Three (3) years of related experience in insurance carriers accounts receivable and payment reconciliations.

Experience with claims audits.

Computer literate MS Office (Word, excel, powerpoint and outlook)

Knowledge of Proclaim billing system (Assertus) preferable.

Knowledge of electronic medical records.

Knowledge in insurance carriers billing requirements (manual and electronic)

Knowledge in insurance carriers appeals and adjustments processes.

Detail oriented, organizational and work under pressure skills.

Superb interpersonal relations skills, and excellent communication with insurance carriers.

Fully bilingual (Spanish and English)

Equal Opportunity Employer:

Nazareno is an Equal Opportunity Employer – Minority / Female / Disability / Veteran / Gender Identity / Sexual Orientation