POSITION SUMMARY
At HiHealthCare we provide the community and health care industry with specialized services that focus on medical facility staffing and in-home medical and nonmedical care. Our goal is to actively pursue a Culture of Excellence through our commitment to the consistent delivery of quality, dependable service, and professionalism. Locally based and locally focused, HiHealthCare is a member of The Hawaii Group family of companies and is the ongoing legacy of Scott Craun, RN and Island Nurses.
The Billing Specialist works closely with the Contracts and Billing Manager in managing relationships with clients, insurance companies, patients, and case managers, providing the highest level of service and care to our patients and clients. This position is responsible for the prior authorizations process and assists billing with claim submission, research, invoicing, and payment tracking.
ESSENTIAL DUTIES
Prepare and submit billing data, invoices, medical claims, and other amounts due to medical procedures and services to insurance companies and state partners.
Monitor and record late payments. Follow-up on missed payments and resolve financial discrepancies.
Assists Medical Biller with weekly billing duties to include but not limited to:
Verifying insurance claim numbers and coverage.
Verifies correct primary/secondary health insurance policies.
Verifies homecare and medical supplies coverage.
Enters appropriate insurance information in EMR system.
Notifies clients of deductibles and co-insurance due. Explores other payment options with customer when needed.
Examine patient bills for accuracy and request any missing information.
Investigate and appeal denied claims and authorizations.
Maintain billing software by updating rate change, cash spreadsheets, and current collection reports.
Collect and review referrals and pre-authorizations.
Monitor and process all incoming faxes received for Authorizations.
Regularly calls insurance companies and case managers to follow up on prior authorization documentation and status.
Determines which patients require further authorizations.
Contacts primary care physicians in regards to referrals.
Ensures that all necessary authorizations are initiated, received, entered into EMR system and notifies appropriate staff of authorizations received and/or further follow up needed.
Acts as point of contact with providers, case managers, and physicians while maintaining positive collaborative relationship.
Keeps sensitive customer and company information confidential.
Protects the company’s value by keeping collection information confidential.
Updates job knowledge by participating in educational opportunities.
Serves and protects the company by adhering to professional standards, company policies and procedures, federal, state, and local requirements.
Participate in company meetings, events and functions.
Support team members when they are out of the office.
Actively contribute to the overall positive culture of the company.
POSITION EXPERIENCE AND QUALIFICATIONS
Experience: Minimum 1 – 2 years of billing role or equivalent experience. Authorization processing experience preferred but not required.
Computer Skills: Proficient at MS Office with intermediate/advance knowledge of Word, Excel, and Outlook. Must have PC proficiency and ability to quickly learn new software applications. Prior experience working on complex cloud-based or internally hosted computer systems. Experience with Axxess or similar EMR system a plus but not required.
Other Qualifications
Moderate level understanding of billing codes, software, and electronic medical records.
Time Management – Demonstrates efficient ability to prioritize tasks and manage time to complete tasks and meet deadlines.
Project Management - Demonstrates project discipline and experience. Must be organized, focused, and driven toward established goals and deadlines.
Accountability - Ability to accept responsibility and account for their actions.
Detail Oriented - Ability to pay attention to the minute details of a project or task.
Analytical Skills - Ability to use thinking and reasoning to solve a problem.
Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.
Communication – Ability to express ideas, needs and decisions clearly through both excellent written and verbal skills.
Customer Oriented - Ability to take care of the clients’ needs while following company procedures.
Interpersonal - Ability to get along well with a variety of personalities and individuals.
Energetic - Ability to work at a sustained pace and produce quality work.
Decision Making - Ability to make critical decisions while following company procedures. Displays willingness to make decisions; exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.
Cultural Awareness – Ability to understand and interpret critical cultural differences at an interpersonal and organizational level. Shows respect and sensitivity for cultural differences; promotes a harassment-free environment.
Other Requirements: Perform other duties as assigned. May be required to work evenings and weekends as necessary. The Company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the Company reserves the right to change this job description and/or assign tasks for the employee to perform, as the Company may deem appropriate.
Reasonable Accommodations Statement
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
BENEFITS
This position is a full-time on-site position with supervisor approval qualifies for following:
Daily employer provided lunch under the HiGroup Daily Grinds Program
Gym/fitness reimbursements
Parking or buss pass subsidy
Cell phone reimbursement
Support of continuing education
12 paid holidays (includes birthday off)
Paid Volunteer Time Off (VTO)
Paid Time Off accrual (PTO)
Flex Work Program
Employee snacks and drinks
Career advancement
401K, 4% matching and profit sharing (after eligibility requirements are met)*
Health benefits