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