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Job Overview: REMOTE 1099 CONTRACTOR POSITION ONLY (NO W-2) ***FAST PACED environment ***A skilled and detail-oriented Medical Billing & Claims Specialist. In this role, you will be responsible for processing and submitting accurate medical claims to insurance companies, ensuring that all claims are compliant with payer requirements, and addressing any issues that may arise in the claims process. Contractors will have strong knowledge of medical billing procedures, insurance guidelines, and the ability to work effectively in a fast-paced environment.

Key Responsibilities:

Claims Submission:

• • Review patient records and clinical documentation to ensure accurate coding and billing of services rendered.
  • Prepare and submit medical claims to insurance companies (including Medicare, Medicaid, and private insurers) using the appropriate billing formats and codes.
  • Ensure that claims are submitted in a timely manner to avoid delays in payment.
  • Closely following Hearts Enteral’ s medical foods system and time frames.

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Claims Follow-Up & Resolution:

• • Track the status of submitted claims and follow up with insurance companies based on Hearts Enteral’ s timeframe to resolve any issues or denials in a timely manner.
  • Making sure the claims Master Report is completed in full and on time for Hearts Enteral’ s weekly meeting.
  • Investigate and resolve claim denials, rejections, and underpayments by communicating with insurance providers and patients.
  • Work with the patient intake department to collaborate that claims are processed correctly, and payments are received.
  • Appeal denied claims, providing necessary documentation and corrections as required, based on Hearts Enteral’ s timeframe.

Coding and Compliance:

• • Ensure accurate coding of medical foods and medical supplies, diagnoses, and services according to ICD-10, and HCPCS coding systems.
  • Stay up-to-date with payer policies, industry standards, and regulatory changes to ensure compliance with billing and coding requirements.

o Verify that all necessary documentation (ex. authorization numbers) is included with claims to support coding accuracy and prevent delays in payment.

· Patient Account Management:

o Review Master Report to ensure that all charges are correct, dates of services, and all products are properly accounted for.

o Communicate with patients to resolve billing inquiries, including health plan payments sent to members immediately.

Documentation and Reporting:

• • Maintain accurate and organized records of all claims, payments, denials, and correspondence with insurance providers in Hearts Enteral EMR Office Ally patient charts.
  • Prepare and submit regular weekly reports on claim status, outstanding claims, and revenue cycle performance.
  • Document all interactions with insurance companies, patients, and internal departments.

Collaboration & Team Support:

• • Collaborate with the intake team, and other departments to ensure the accuracy and completeness of claims.
  • Work closely with the intake team, specialists and departments to identify and resolve any issues affecting the revenue cycle.
  • Provide training and support to other team members as needed.
  • Insurance Payer Enrollment:
  • Ensure providers are enrolled with necessary insurance payers and networks
  • Research and identify all insurance companies and networks a provider should be enrolled with. The goal is to be enrolled with all insurance companies including Medicare and Medicaid.
  • Submit credentialing applications to payers, ensuring all required documents are included.
  • Track payer responses, following up on pending applications to ensure timely approvals.
  • Maintain Hearts Enteral’ s insurance payer credentialing tracker for each provider.

Other duties:

• Assist with any other projects directed by management

Hearts Enteral DME is the sister company of our non-profit organization Compassion Works Medical. Our mission is to help fight the challenges of healthcare reimbursement for people who struggle with rare diseases and conditions that require enteral nutrition and medical foods to sustain and prolong their lives. Web. www,heartsenteral.com. www.compassionworksmrs.com.