Billing and Claims Specialist

Description OBJECTIVE:

Assist in the overall daily office and administrative activities to support the Children & Family Services division of Lumibility.

• High school diploma/GED required
• Bachelor’s degree in related field preferred
• Proficiency in Microsoft Office software including Word, Outlook, and Excel
• Must possess a valid Connecticut driver’s license, have an acceptable driving history and be able to utilize your own vehicle for Lumibility business as defined by Lumibility’s policy
• Bilingual (Spanish) preferred
• Experience with medical billing, insurance reimbursement and reconciliation, preferably in a clinical/medical environment required
• ICD/10 and CPT coding experience required
• Knowledge of insurance/Medicaid practices required
• Ability to recognize discrepancies in billing data and investigate the issue to determine resolution
• Excellent interpersonal skills and phone interactions
• Must have strong organizational skills and the ability to work in a fast-paced environment
• Must have internet access, a cell phone, private workspace, and reliable transportation

Hours: 40 hours/week, M-F, Non-Exempt

Location: Hybrid

Pay Rate: $24 - $26 per hour

• Input employee and independent contractor billing information into state database accurately and expeditiously to ensure proper records handling and prompt payment responses
• Initiate internal billing corrections and voids process according to procedure and make corrections in agency and state database
• Run reconciliation reports to identify data and billing errors, adjudication reports and follow up to make corrections
• Enter client data from eligibility documents including insurance forms and statements of eligibility into state database
• Review and identify errors proactively and take necessary action to track and resolve
• Work collaboratively with the state contacted billing company, opening tickets, investigating and working claims, adjudication, denials, appeals and reimbursement
• Update job knowledge by participating in training opportunities and keeping current on state contract, insurance billing and reimbursement procedures. Adhere to company standards and federal and state requirements
• Maintains communication with other departments to promote positive working relationships and open communication
• Develop processes to address systems (embed resources and procedure changes into office procedures, create a day-to-day task priority list, determine needed changes to current procedures, create checklists for checks and balances and revise as needed)
• Verify insurance information in state and private insurance company database
• Enter insurance information in state database
• Participate in state led Community of Practice meetings and subcommittees, work collaboratively with Business Operations Manager to generate and maintain procedures related to the Billing & Claims position
• Perform other roles within the office team to provide support as requested
• Contribute during meetings and training sessions
• Performs other duties as assigned.
• If bilingual, provides interpretation for families during phone conversations and verifies translated documents as needed.

• Knowledge of medical billing and insurance reimbursement
• Knowledge of medical coding preferred
• Knowledge of company policies and procedures and applicable regulatory requirements and standards
• Skill in data entry, analyzing information, documentation and reporting
• Skill in planning, organizing, attention to detail and work in a fast-paced environment
• Skill in problem solving and decision making
• Skill in operating standard office equipment, computer and various software packages
• Skill in communicating effectively in a courteous and professional manner
• Skill…