Program Billing Specialist

Definition

Works with the clinical staff and managers of assigned programs to ensure services are authorized, documented, billed, and paid in a timely and effective manner. Maintains cooperative relationship with all staff to ensure the best service is provided to the agency and CTO as the point of contact for the clinical staff for assigned programs for any billing-related questions, problems or data requests related to the assigned programs.

• Enters billing data from clinical documentation to generate accurate billing charges in accordance with funding source requirements.
• Reviews and verifies incoming clinical documentation for completeness, accuracy, and compliance with timeliness and payer-specific standards.
• Collaborates with manager/supervisor to ensure electronic billing charges and corrections are completed timely to support maximum reimbursement.
• Researches insurance claim denials, determines claim validity, and adjusts and resubmits claims through appropriate submission methods when warranted.
• Inputs and maintains billing-related data in billing systems in accordance with established procedures and controls.
• Maintains required performance data and billing and collections metrics.
• Ensures eligibility and billing exceptions identified in the 271 eligibility file and 837 billing file are corrected and updated in the billing system in a timely manner; follows up with clinical staff to resolve data issues prior to the next billing cycle.
• Proactively identifies, prevents, and assists in correcting CDC errors in PICIS, and supports staff in determining CDC status and appropriate corrective actions.
• Proactively ensures all required eligibility information is obtained and updated timely to support accurate billing and maximum reimbursement; communicates barriers to timely and accurate billing to appropriate management.
• Responsible for staying knowledgeable about and adhering to HIPAA regulations as well as other state, federal and agency regulations related to confidentiality of consumer health information.
• Performs other duties as required and/or assigned by supervisor and/or executive staff.
• Responsible for notifying supervisors of any training deficiencies that impair the PBS's ability to perform their duties.

• High school diploma or equivalent and one (1) year of responsible administrative experience and knowledge of Medicare/Medicaid billing.
• Proficiency in the use of Microsoft Office software, or equivalent and intermediate general computer skills.
• Excellent interpersonal skills and the ability to work cooperatively with various types and levels of staff required.
• Must demonstrate the ability to effectively communicate both verbally and in writing.
• Must be able to organize and manage large volumes of paper and comprehend and interpret verbal and written instructions.
• Checks Agency Email and Voice Messages daily and responds promptly.
• Must be able to sit for extended periods of time at a computer station. Must be able to bend, stoop, move about facilities freely, have upward and downward mobility for filing, climb stairs and have finger dexterity.
• Must complete all North Care required training within 30 days of employment with North Care.
• Must have TB test within 12 months prior to employment with North Care or obtain within 30 days of employment with North Care.
• North Care employee is responsibility for adhering to any and all laws, professional standards and ethical codes that apply to his/her job responsibilities.

• Entry level

• Full-time

• Other

• Hospitals and Health Care