Billing Specialist

Position Summary:

This is a full-time hourly (non-exempt) position. Overall goal is accurate charge entry and timely collection of monies due from various carriers and patients for medical, dental and behavioral health claims.

Essential Functions:

Post encounters as assigned and verify all Insurance Carriers

Audit and chart review in a timely and accurate manner for coding and billing compliance, review all posted encounters for assigned pay codes.

Make sure assigned codes meet all federal, legal and insurance regulations.

File secondary claims and follow through.

Submit all approved tickets electronically to the clearinghouse and retrieve and process reports from them or print them on paper, if necessary.

Post payments received from third party payers manually, or if electronic posting is enabled for payer, review for oddities and make corrections when needed.

Resubmit denied claims after review and corrections are made.

Run aging detail and monitor old claims for payment status and correct as necessary monthly.

Ensure all measures are exhausted to collect from Insurance carrier before claim is submitted to Revenue Cycle Manager for approval to write off.

Inform the Manager of any issues that arise.

Provide training for the front desk staff on insurance carriers on an as needed basis.

Assist providers or procedure entry staff with coding for encounters and/or hospital billing

Monitor regulatory changes pertaining to Medicare, Medicaid, and Commercial insurance.

Credentialing duties as assigned providers with all insurance carriers.

Work on special billing/financial projects and train new employees as requested.

Attends billing seminars and workshops as needed.

Working knowledge ICD-10, current procedural coding.

Other duties as assigned.

Knowledge, Skills and Abilities:

Excellent communication skills; active listening as well as written and oral comprehension/communication skills;
Gives full attention to what individuals are saying, understands the point being made, asks appropriate questions to gain better knowledge of situation(s) and repeats information to ensure understanding; public speaking skills necessary; bilingual (English/Spanish) language skills helpful

Excellent customer service skills actively seek ways to assist internal and external customers within the scope of assigned duties

Good basic mathematical skills use a calculator or other means to accurately assist in financial matters

Good computer skills;
Outlook, Windows, Microsoft Office, Excel applications.

Good time management skills self-evaluate the use of time and understands how others may be affected

Cultural diversity awareness and skills; respects all people regardless of race, nationality or social standing

Ability to work independently (self-motivating) and as a team member

Ability to develop a collaborative therapeutic alliance with individuals and make accurate professional judgments

Ability to build and maintain effective working relationships with co-workers, providers, managers, patients, agency resource personnel and community members in general

Familiarity with local community resources for patients with chronic disease

Knowledge of the health and human services infrastructure, health insurance programs and public coverage options

Problem sensitivity skills; empathetic/understanding

Deductive reasoning and problem-solving skills

Organized and detail-oriented

Familiar with Prior authorizations and referrals as needed for claims.

Education, Experience and Licensure:

High school diploma or equivalent (GED) required

Degree or Certificate in Billing/Coding preferred

Certified in Medical and/or Dental coding preferred

Two years' experience required

Computer knowledge required;
Windows, Microsoft Office applications and Practice Management Systems

Prior experience in professional office environment preferred

Physical Demands:

May sit and/or stand for long periods of time

Must be able to see and hear within normal range with or without correction device(s)

Dexterity and hand-to-eye coordination as normally associated with operating office equipment, computers and telephone

Working Conditions:

Professional, fast-paced office environment