Medical Claims Billing Associate
New York, NY, USA
Posted on Thursday, November 30, 2023
Pelago is the world’s leading virtual clinic for Substance Use Management. Our program provides guidance, support and treatment for members seeking to overcome their tobacco, alcohol and opioid use. From unhealthy habits to active substance use disorders, Pelago delivers a personalized solution based on individual health, habits, genetics, and goals, providing care for members wherever they might be on the substance use spectrum.
Pelago's suite of virtual services ranges from education, to cognitive behavioral therapy (CBT) to comprehensive medication-assisted treatment (MAT).
Pelago enables employers and health plans to deliver accessible, affordable, and effective treatment for substance misuse.
- Manage the submission and reimbursement of claims bill to insurance companies using ICD-9 coding.
- Accept and process healthcare claims and confidential medical records; verify patient eligibility and manage the billing process.
- Verify correct ICD-9 and CPT codes for a variety of specialties submission of electronic claims to clearinghouse.
- Ensure appropriate medical terminology and HIPAA compliance for all claims entry/online submissions, payment posting, insurance and patient aging.
- Verify and ensure accuracy, completeness, and specifics of ICD-9 codes and HCPC codes.
- Acquire knowledge of confidentiality and HIPAA guidelines
- Post payments from insurance companies and patients, post medical record payments, verify patient insurance and eligibility
- Assist coworkers with difficult claims/system issues
- Billing System Management. Enter all patient and third party payer information into the billing systems
- Prepares monthly reconciliations of accounts receivable and various revenue analysis reports
- Perform other Billing duties on a daily basis including, but not limited to, address changes, member/policy maintenance, monetary adjustments, new account set-up, dispute research and resolution, fraud research, receivable collection on accounts and quality review
- Knowledge of all third party payer billing rules and regulations
- Ensure timeliness and quality of billing
- Perform validation activities at all steps of the billing cycle
- Act as asingle point of contact and manage billing queries by taking proactive ownership of issues (assign priority, owner, timescales) and drive resolution
The background we're looking for:
- Associate’s degree in Business, Accounting or related field is preferred but not required
- A background demonstrating the ability to work independently part of a team
- Strong analytical and problem solving ability is necessary
- One to three years experience performing in a related field
- Filing client contracts and requests
- Professional attitude and service oriented