Job Description

Commercial Insurance Biller

Avalon Health Care Management, Inc. in Salt Lake City is hiring a Commercial Insurance Biller to come join our outstanding team! We are seeking an experienced Commercial Insurance Biller to join our team. The ideal candidate will have a strong background in medical billing and coding for Skilled nursing facilities, as well as experience working with commercial insurance companies. This position has the opportunity to become a hybrid role working from home and in office after training. Full-time are eligible for: 401K Medical, Dental & Vision FSA & Dependent Care FSA Life Insurance AD&D, Long Term Disability, Short Term Disability Critical Illness, Accident, Hospital Indemnity Legal Benefits, Identity Theft Protection Pet Insurance and Auto/Home Insurance.

Responsibilities:

• Review and follow up with the facilities to ensure facility has received authorization to provide services to commercial insurance payers.
• Ensure all rates are correct within the billing software.
• Bill according to the outlined billing schedule as set by the Avalon Corporate Office.
• Prepare, review, and transmit claims using billing software through electronic and paper claim processing.
• Provide claim follow up based on Avalon claim review protocol.
• Contact commercial insurance providers through phone and online review of outstanding claims.
• Follow up process will continue until claims are reduced from outstanding Accounts Receivable (AR).
• Research and review outstanding claims until the AR payer has been relieved.
• Process refunds and adjustments according to Avalon guidelines.
• Collect and process the payment as indicated on the Explanation of Benefits (EOB) for patients' dates of service.
• Payments which are not equal to outstanding AR will be researched and reprocessed for refunds, additional payment request, or adjustment needs.
• Work effectively with facility personal to resolve billing issues.
• Complete monthly aging for facilities and attend aging review meetings when necessary.

Qualifications:

• Must have experience billing for Skilled nursing facilities
• Associate's degree (AA) or equivalent from two-year college or technical school; or two or more years related experience and/or training; or equivalent combination of education and experience.
• Minimum 2 years of billing experience.
• Ability to adapt to a flexible work schedule.
• Ability to relate positively, effectively and appropriately with residents, families, community members, volunteers and other staff.
• Possess special interest in, and a positive attitude about, working with long-term care residents and the elderly.
• Ability to read, write, speak and understand English.
• Demonstrate basic computer knowledge and ability, including e-mail, with an aptitude to learn company applications.

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