Medical Biller - PCR

Why Peoples?
Peoples Health Services is the only family-owned, locally governed Hospice and Home Health provider in the Florida Panhandle. We believe that when we take care of the people who care for our patients, everyone benefits. We offer competitive pay, medical, dental, vision, group life, short-term disability benefits, a PTO program, 6 paid holidays, recognition programs, and work-life balance initiatives including a Relax & Recharge Day annually. Join a team that is dedicated to caring for our community—and each other.

Position Summary:

The Business Process Specialist--Biller-PCR is primarily responsible for performing all tasks required for the Medicare Pre-Claim Review process including but not limited to obtaining, reviewing, and accurately submitting all documentation required for pre-bill audits (both initial submissions and resubmissions). Additional responsibilities include ability to perform all authorization and billing department functions. All Employees agree to abide by and demonstrate the mission, vision, and guiding principles of Peoples Home Health.

Essential Duties & Responsibilities:

• Works with members of all internal departments to include Intake, Sales, Coding and Billing to ensure accurate and timely submission of PCR documentation
• Works with billing department on follow-up regarding PCRs and all other billing department functions and duties
• Coordinates and assists with Document Control regarding physician orders for billing and PCR purposes
• Provides back up assistance to billing, authorization, and scheduling departments.
• Completes all necessary documentation for initial authorization in accordance with the insurance company contracts. 
• Supervises requests for all follow-up authorization, notification of staff of all authorizations received and visit limits as well as need to discharge client due to denial for further authorization. 
• Interrelates with coworkers, clinical staff, visitors, and other departmental personnel in a tactful, diplomatic manner while always exercising discretion, good judgement, and confidentiality.
• Attends all scheduled meetings and in-services prepared to give a detailed summary and update of PCR status.  
• Implements and monitors action plans as indicated to ensure compliance with regulatory guidelines
• Works with minimal supervision. Proactively handles customer issues as they arise and seeks assistance from others as needed.
• Maintains an understanding of the company’s scope of services.
• Understands the infrastructure and how and where to transfer calls in the company.   
• Maintains a professional image.
• Uses appropriate phone etiquette. 
• Promotes a customer friendly atmosphere for all visitors and ensures client confidentiality at all times. 
• Types reports, business correspondence, memos, schedules, and other documents that may be needed in a timely fashion and with accuracy.
• Participates in accreditation program.
• Performs other duties as assigned.

Education/Experience:

• High School Graduate (or equivalent) required 
• Minimum three (3) years’ Home Care Office experience is preferred.
• Knowledge of billing, insurance reimbursement, medical terminology, diagnosis coding preferred. 
• Experience with trouble shooting computer errors, maintaining records, and organizing is preferred. 
• Proficiency using Microsoft Word and Excel is required. 
• Ability to prioritize and manage time effectively and make independent decisions when necessary.
• Excellent interpersonal, verbal, and written communication skills
• Excellent analytical and troubleshooting skills.

Working Conditions:

Office Environment. May be exposed to biological hazards.