Medical Billing Specialist - Medicare Advantage
Health Partners, Lima, OH, United States
Medical Billing Specialist - Medicare Advantage
Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We're led by a volunteer Board of Directors. Most of our board members are also patients. Our mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care.
Position Purpose
With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to Medicare Advantage Payers to support an efficient and effective revenue cycle.
Essential Functions and Basic Duties
Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billing
Prepare, review, submit, and track insurance claims to Medicare Advantage payers in accordance with FQHC, state, and federal billing requirements
Process insurance reimbursements and reconcile remittance reports with payments received
Monitor accounts receivable aging and actively follow up on unpaid or underpaid Medicare Advantage Claims.
Identify Medicare Advantage denial trends, systemic payment issues, and eligibility discrepancies
Resolve payment credits and overpayments through claim corrections, refunds, or payer coordination in compliance with CMS and federal regulations
Maintain current knowledge of FQHC billing rules, CPT, CDT, and ICD?10?CM coding requirements
Respond professionally and knowledgeably to inquiries from patients, providers, and insurance representatives
Coordinate with internal teams (including Medicare, Medicaid, Managed Medicaid, and third-party insurance teams) to resolve shared or complex claim issues
Review and process incoming correspondence related to claims and payments
Maintain organized electronic claim, payment, and correspondence records to support audits and reporting
Safeguard patient information in accordance with HIPAA and health center confidentiality policies
Perform other job-related duties as assigned
Qualifications
High School Degree or GED Required.
Successful completion of in-house training.
Experience with healthcare billing preferred.
Skills/Abilities
Working knowledge of multiple insurance types, including Medicaid, Medicare, and commercial payers
Understanding of basic medical and billing terminology
Ability to manage time effectively and prioritize tasks in a deadline-driven environment
Strong analytical skills with the ability to critically evaluate available information and make informed decisions
Moderate technical proficiency with the ability to work simultaneously across multiple systems and platforms, including Excel, practice management systems, and Microsoft Teams
What We Offer
Starting pay $21.60 and goes up based on experience in Federally Qualified Health Center billing
Paid Time Off (PTO) Accrued per pay
Insurance (Medical, Dental, Vision, Life and Disability)
Paid Holidays 7 paid holidays
403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
Annual Reviews and Increases
Employee Assistance Program
Referral Bonus Earn more by expanding our team
Training Opportunities
Eligible to apply for the Emerging Leaders Program after 1 year of service
Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We're led by a volunteer Board of Directors. Most of our board members are also patients. Our mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care.
Position Purpose
With knowledge of FQHC billing requirements, the Accounts Receivable Specialist prepares, submits, and follows up on insurance claims to Medicare Advantage Payers to support an efficient and effective revenue cycle.
Essential Functions and Basic Duties
Review insurance coverage and patient demographic information to ensure accuracy and completeness prior to billing
Prepare, review, submit, and track insurance claims to Medicare Advantage payers in accordance with FQHC, state, and federal billing requirements
Process insurance reimbursements and reconcile remittance reports with payments received
Monitor accounts receivable aging and actively follow up on unpaid or underpaid Medicare Advantage Claims.
Identify Medicare Advantage denial trends, systemic payment issues, and eligibility discrepancies
Resolve payment credits and overpayments through claim corrections, refunds, or payer coordination in compliance with CMS and federal regulations
Maintain current knowledge of FQHC billing rules, CPT, CDT, and ICD?10?CM coding requirements
Respond professionally and knowledgeably to inquiries from patients, providers, and insurance representatives
Coordinate with internal teams (including Medicare, Medicaid, Managed Medicaid, and third-party insurance teams) to resolve shared or complex claim issues
Review and process incoming correspondence related to claims and payments
Maintain organized electronic claim, payment, and correspondence records to support audits and reporting
Safeguard patient information in accordance with HIPAA and health center confidentiality policies
Perform other job-related duties as assigned
Qualifications
High School Degree or GED Required.
Successful completion of in-house training.
Experience with healthcare billing preferred.
Skills/Abilities
Working knowledge of multiple insurance types, including Medicaid, Medicare, and commercial payers
Understanding of basic medical and billing terminology
Ability to manage time effectively and prioritize tasks in a deadline-driven environment
Strong analytical skills with the ability to critically evaluate available information and make informed decisions
Moderate technical proficiency with the ability to work simultaneously across multiple systems and platforms, including Excel, practice management systems, and Microsoft Teams
What We Offer
Starting pay $21.60 and goes up based on experience in Federally Qualified Health Center billing
Paid Time Off (PTO) Accrued per pay
Insurance (Medical, Dental, Vision, Life and Disability)
Paid Holidays 7 paid holidays
403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
Annual Reviews and Increases
Employee Assistance Program
Referral Bonus Earn more by expanding our team
Training Opportunities
Eligible to apply for the Emerging Leaders Program after 1 year of service