General Description
The Billing Specialist is responsible for providing support to the Revenue Cycle Department. This position manages a very high volume of claims and must work quickly and efficiently to manage the consistent flow of work. This position may also serve as a primary subject matter resource for residential billing.
Tasks & Responsibilities
A. Essential Duties
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Generates insurance claims and collects outstanding insurance balances.
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Prepare and submit accurate OON claims for residential behavioral health services (Residential Billing only).
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Submits appeals and reconsiderations to insurance companies.
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Makes follow-up calls to the insurance companies on accounts with outstanding balances.
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Maintains standards to ensure systematic, consistent, and timely collection follow-up.
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If claims are denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database.
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Ensure medical records needed for billing purposes are in client’s charts and/or submitted.
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Completes all payer rejections in a timely manner in accordance with department standards.
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Identifies, separates, and mails claims that require paper submissions for timely submission.
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Monitors provider enrollments to assure that claims process correctly to ensure timely reimbursements.
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Reviews, researches, and amends correspondence/explanation of benefits and makes appropriate adjustments to accounts.
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Identifies and communicates possible system and reimbursement problems to facilitate an efficient and accurate review of the payers.
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Meets billing compliance standards.
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Contact insurance carriers to have claims reprocessed in accordance with contracts and plan benefits.
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Protects Facility value by keeping collection information confidential.
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Update job knowledge by participating in continuing education opportunities.
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Review billing reports identify areas that need attention.
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Provide supervisor with follow up from billing reports.
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Bi-weekly supervision.
B. Additional Duties
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Assists and covers other staff when necessary to maintain high productivity and efficiency in the department.
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As the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.
C. Interpersonal Relations
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Create Meaningful Connections: Demonstrates ability to function effectively as a part of team. Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.
- Take Accountability: Take constructive feedback and prevent discourse among our peers.
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Live in the Solution: Critically thinking should be the solution when problems arise. Having the ability to accepts constructive criticism well in an open and non-defensive manner.
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Be Professional: Wear business casual attire (please see dress code policy).
Competencies
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Adaptability
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Customer Service
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Decision Making
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Dependability
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Ethics
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Interpersonal Skills
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Job Knowledge
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Conflict Management
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Organization Skills
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Productivity
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Self Development
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Teamwork
Performance Standards & Measurement
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Compliance with essential and incidental duties; compliance with company policies and procedures.
- Compliance with state and federal laws and regulations applicable to the business.
Equipment, Tools & Machines
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Use of computer, telephone, and other office equipment such as a printer and fax.
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Use of company network and email domain.
Working Conditions
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Air conditioned and well-illuminated office environment and outdoor environment.
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May have several responsibilities at once. Interaction with others is constant and can be interruptive.
- Work may be stressful at times due to high level workflow.
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Availability to work flexible hours including weekends, holidays, and evenings as is required to comply with the purpose of the job and accommodate client needs.
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Participates in educational training, orientations, or compliance programs as needed to maintain competency.
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If you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.
Demands
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Enthusiastic self-starter operating with sustained energy and showing great initiative.
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Comfort working with a diverse base of support, including members, employers, providers, colleagues, community leaders, volunteers, non-profit organizations, vendors, etc.
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Excellent interpersonal and communication skills, including ability to read, write, spell in English legibly and without excessive grammatical or communication errors.
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Talk and hear both by person and by telephone; ability to speak clearly and effectively using proper grammar before patients, employees and business partners, among others.
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Excellent organizational skills.
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Accepts constructive criticism well in an open and non-defensive manner.
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Ability to manage conflicting priorities. Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.
- Ability to function independently and with flexibility.
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Ability to work under pressure, handle multiple tasks and interruptions.
- Occasional lifting of moderately heavy office supplies; ability to lift supplies for community events, trade shows, conferences, and other marketing opportunities applicable to the organization; ability to lift, push or pull up to 25lbs.
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Ability to sit, stand, or walk for extended periods of time.
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Must have strong computer skills to meet Microsoft Office and Electronic Health Record software requirements.
Qualifications
Education:
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High School Diploma or equivalent; Billing and Coding Certification from one of the following national certification exams:
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American Medical Billing Association - Certified Medical Reimbursement Specialist (CRMS) Board Exam
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AAPC - Certified Professional Coder's (CPC®,) Certified Outpatient Coder (or CPC-HCOC™) [formerly CPC-H®,] Certified Inpatient Coder (CIC™,) or Certified Professional Medical Auditor (CPMA®) Board Exam
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American Health Information Management Association - Certified Coding Associate (CCA®,) Certified Coding Specialist (CCS®,) or Certified Coding Specialist Physician-Based (CCS or CCS-P®) Board Exam - The CCS & CCS-P credentials require experience in addition to the education
Experience:
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Billing and Coding: Minimum of 1 year
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CPT and ICD coding
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Computer literate: Microsoft Office (Excel, Word, and PowerPoint) required.
