Wage range: $25 - $34 per hour
Status: Non-Exempt
Location: Remote
Schedule: Monday - Friday

What does the HMO Billing and Collections Specialist do?

In this role you will be responsible for recording all revenue, electronic claim submissions, and timely collection from all HMO payer sources. If you have a keen eye for detail, ensure timely follow up, and love to “check things off,” this role is for you!

In This Job, Every Day You Will:

Monitors HMO claims by reviewing and clearing HMO dashboard daily, verifying eligibly, reviewing case management software, and ensuring payer and claim form is set up in patient records. Ensures all billing and collections are pursued in a timely and effective manner for assigned centers, including researching, adjustments and rebills as needed. Identifies reconsiderations, appeal opportunities, and collaborates and coordinates with facility staff to fulfill audit requests. Completes HMO Triple Check with assigned centers to ensure UB-04 claim forms are correct and all revenue is accounted for and booked correctly. Ensures HMO billing is submitted by the 5th day and verifies receipt of claims by the 7th business day.Follows Prestige collections policy for all HMO payers and reports in a timely manner. Documents all collection efforts in the patient billing record and healthcare software. Reviews business intelligence software data and revenue cards and posts all revenue in company’s healthcare software. Ensures revenue is properly booked and billed by utilizing exclusion worksheets. Research denials and over/under payments for all HMO claims. Submits and processes all revenue adjustments and saves documentation according to company policy. Maintains in-depth knowledge of all HMO contracts and contract changes. Provides education and communication to team members regarding HMO contracts. Maintains constant communication with the centers Administrator, Business Office Manager (BOM), Admission Director, and Regional Manager of Field Accounting (RMFA). Performs other duties as assigned.

Education & Experience You Need to Qualify:

Associates degree in business, accounting or finance or equivalent knowledge and skills obtained through a combination of education, training, and experience. Minimum of 2 years’ experience in a healthcare or accounting environment with an emphasis on HMO contracts, billing, and collections. Knowledge of HMO contracts and Medicare/Medicaid regulations preferred. Ability to creatively problem-solve, be a team player, be well organized and flexible. Experience in the development and training in accounting procedures and rules, and multi-site coverage an asset. Must be proficient with Microsoft Excel, accounting software, and experience with EHR and billing systems/software.

Ways you can advance beyond the Senior Maintenance role:

Once you master this role, you could consider the Regional Manager of Field Accounting or the Director of Field Accounting positions.

EOE/M/F/VETS/DISABLED – At Prestige, it is our promise to personally touch lives every day. It is a philosophy of caring based on our core values of integrity, trust, commitment, and respect, that are at the center of all that we do. We are committed to a diverse and inclusive workforce that represents all of us, coming from different experiences, cultures, backgrounds, and viewpoints. Inclusion is the way we treat one another and how we celebrate what makes us different.

Prestige is proud to be an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

Who is Prestige Care/Prestige Senior Living?
Prestige Care is a family of over 75 skilled nursing + post-acute care centers, as well as assisted living and memory care communities in 8 Western states. We are an organization of over 5,000 team members who serve thousands of residents, where we have the privilege of personally touching their lives every day.
We have four core values of integrity, trust, commitment, and respect that guide everything that we do. With a strong commitment to career development and advancement, Prestige Care is a employer that can help you achieve your career goals and objectives. With a healthcare career at Prestige Care, you will enjoy a collaborative, team-oriented environment where your work truly matters at the end of every day.
Summary of Benefits
Full-time team members are eligible for Prestige’s comprehensive benefit package including choice of medical plans, HSA/FSA accounts, dental and vision insurance, and company paid life and AD&D insurance. All team members are eligible to participate in the company’s retirement plans with a company match for those who meet the hours and service requirements. Additional benefits include Employee Assistance Program and Education Reimbursement program.
PTO:
SNF/AL/PCI Salary: Accrue PTO at rate of 0.0615/hour during their first year/16 days.
SNF/PCI Hourly: Full-time and Part-Time team members (over 20 hours/week) accrue PTO at rate of 0.0423/hour during their first year.