Career Ladders:

NELC's auditing department offers career ladders to auditors. Candidates who achieve excellent performance in their job duties, who demonstrate a commitment to personal development, participation in department and company strategic programs and projects, who develop superior working relationships inside and outside the department and who show a commitment to the success of the department are eligible for promotion to the following positions: Accounts Receivable Specialist - represents an entry level position into the department. Candidates who meet defined goals, objectives and accomplishments can generally expect to be promoted in 2-3 years to: Senior Accounts Receivable Specialist - Candidates who meet defined goals, objectives and accomplishments and who demonstrate engagement and ownership of departmental and organization activities would generally expect to be promoted in 4-5 years to: Lead Accounts Receivable Specialist - Candidates who are part of the department leadership team and who have responsibility for advanced departmental, company and member hospital engagement. •Only hiring remotely in the following states: Connecticut, Florida, Maine, Massachusetts, Maryland, New Hampshire, North Carolina, Ohio, Rhode Island, Texas, and Vermont•

Benefits:

Remote / Hybrid Position Career Ladders Health Insurance Career ladders and opportunities for advancement Dental insurance Vision insurance Generous employer-matched 403b savings program Company paid: Life insurance, Short- and long-term disability insurance Paid time off And much more!

Primary Responsibilities:

Achieve performance appraisals with \"meets expectations\" or better Demonstrate independence and competence to work basic denials Demonstrate independence and competence in payer requirements for basic appeals Demonstrate independence and competence and ability in submitting correct claims for payers Demonstrate independence and competence in refund processing Demonstrate independence and competence and ability to teach how to check claim status via phone or website Demonstrate ability to complete on average 20 accounts per day Demonstrate ability to work accounts timely within 2 weeks of receiving denial or needing follow up Maintain audit percentage of 98% Follows NELC policies and procedures in the normal conduction of company business. Assures that professional practice complies with state and federal regulations including, but not limited to the HIPAA Privacy and Security regulations and NELC's Corporate Compliance Program. Ensures that confidentiality of patient information is maintained in accordance with state and HIPAA Privacy and Security regulations. Effectively communicates both verbally & in writing inside and outside the organization; selects appropriate means of communication; questions to seek clarification and understanding; maintains confidentiality; listens actively to others; conveys appropriate information to others. Takes the initiative to meet internal and external customer needs in a timely and courteous manner; maintains a high level of customer satisfaction; follows up on customer complaints/concerns. Establishes and maintains good working relationships; shows respect and concern for the feelings of others; interfaces effectively with all levels of the organization; focuses on situations rather that personalities in relating to others; works cooperatively within a group; accepts constructive feedback. Displays good judgment; takes the initiative rather than waiting to be told; make practical suggestions; learns from past experiences and uses those insights to handle new situations effectively; defines problems logically and develops appropriate solutions; uses creative approaches. Completes appropriate amount of work in a timely manner without jeopardizing quality; uses time effectively to consistently accomplish objectives and meet deadlines; organizes workload for requirements of the job; set priorities and discriminates between important and unimportant matters; anticipates needs/problems; maintains attention to detail.

Required Qualifications:

A minimum of 3 years' experience with third party health insurance claims office or plan administrator involved in processing health provider claims required. A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required. Experience with healthcare patient accounting/billing/collections computer applications including electronic claims processing preferred. Working knowledge of Home Infusion Therapy billing & collection preferred. Practical experience with Medicare; Medicaid; and third-party payer contracts.

Preferred Experience:

Associates Degree or bachelor's degree in Business Administration preferred.

Regulatory requirements:

Knowledge of HIPAA Privacy and Security requirements. Working knowledge of federal / state fraud and abuse laws required.

Skills :

Demonstrated knowledge of medical terminology; CPT; ICD9; and HCPC coding required. Excellent customer service skills required. Excellent communications (verbal and written) skills required. Excellent organizational skills required. Ability to work independently as well as part of a team required. Practical experience with microcomputer systems and applications to include Microsoft Word and Excel required. Demonstrated ability to identify, research and solve problems required. ''It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.'' 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