Billing Specialist II

Location: Kirkland

JOB SUMMARY:

The Billing Specialist is responsible for all aspects of billing inpatient and outpatient claims. The Billing Specialist, a key position in the Revenue Cycle, facilitates the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues.

Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

REPORTING RELATIONSHIPS The position reports to the Billing Manager. No staff report to this position.

JOB DUTIES AND ESSENTIAL FUNCTIONS
· Prepares and submits clean claims to third party payers either electronically or by paper
· Follows billing guidelines and legal requirements to ensure compliance with federal and state regulations
· Respond to account inquiries from patients, payers, providers, and/or other staff as requested
· Identifies and resolves patient/insurance billing issues
· Work closely with team members regarding claim appeals, denials, resolution, and education
· Performs and monitors all steps in the billing processes to ensure maximum reimbursement from patients, government, and commercial payers as well as from special billing arrangements
· Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Updates business office staff, clinics, residents, and faculty of changes as appropriate
· Responsible for ensuring all new providers are oriented to coding, billing, and documentation compliance
· Responsible for the continuing coding, billing, and documentation education for all providers and residents
· Use online healthcare databases and other resources for verification and claim status
· Deliver the highest quality service to internal and external customers
· Assist other members of the team with projects as needed
· Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
· Other duties as assigned by management
· Adhere to the Mission and Values of MNHCQUALIFICATIONS
· High School Diploma/GED with minimum 3 years billing experience
· Must have strong knowledge of all guidelines for ICD-10, CPT/HCPCS codes, medical terminology, and billing processes
· Knowledge of Medical Billing/EHR (Electronic Health Records) systems preferably Medent
· Knowledge of EOBs, EFTs and ERAs
· Knowledge of Microsoft Office software
· Must be focused, self-directed, organized, and have demonstrated problem-solving abilities
· Accurate and precise attention to detail
· Excellent verbal and written communication skills
· Able to work both independently and as part of a team
· Must possess team leadership skills and have a positive disposition REQUIRED QUALIFICATIONS
· FQHC Billing
· Certified Professional Coder or equivalent experience in years
- Medical, Dental and Behavioral health coding experience required PACE CARD Metrics
· All I/P accounts will be billed within 21 days from the date the chart is completed by physician.
· All residents receive coding education prior to mid-terms.
· Average AR days greater than 120 days are less than or = 15% of total receivables.
· Overall Average AR days are less than or = 35 days.
· Reduce the number of timely files denials to less than or equal to 1% of gross I/P charges as tracked by adjustment code PHYSICAL DEMANDS:
The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job.

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