SUMMARY
This Billing Specialist position is responsible for correcting, completing, and processing service claims for all payer types. He / She is also required to generate reports from both the billing system and the clearinghouse system in accordance with established procedures. This person has public contact of a limited scope, involving routine and standard information exchange with payers, the clearinghouse, client responsible parties and other employees when necessary. This person reports to the Billing Manager.
ESSENTIAL DUTIES & RESPONSIBILITIES
DAILY
- Review claims for submission to payers which may include federal, state, private or third-party payers.
- Review payments received via paper or electronic means to post, balance and research payments and any discrepancies.
- Communicate, collaborate and coordinate with fellow billing, clinical and financial staff to efficiently and effectively problem solve.
- Proactively research trends via reporting and daily processing to recommend changes, updates or opportunities to increase efficacy in department.
WEEKLY
- Scrub, compile and review claims related to periodic billing grants and contracts for accuracy, completion and timeliness.
- Submit billing files, timely and accurately, to specific payers via various portals/systems, research any issues arising from this process including rejections, denials, etc.
- Provide status updates on all outstanding claims to department and team leaders to proactively find patterns and issues as they arise.
MONTHLY
- Review AR Aged Trial Balance with department and team leaders to identify patterns and issues as well as to communicate successful or troublesome payers.
- Maintain meticulous records to track progress on each account worked.
- Thoroughly review accounts worked to ensure timeliness, accuracy and completeness in billing, payment posting, denial research and appeal submissions, then communicate issues to appropriate parties.
PERIODIC/REGULAR
- Participate in team meetings as needed.
- Communicate with internal and external parties professionally and timely to maximize performance of the billing and collections team.
- Provide excellent customer service to internal and external stakeholders.
EDUCATION & EXPERIENCE
- High School diploma or equivalent is required.
- A minimum of 2-3 years billing experience is required.
- Coding experience preferred but not required
- Previous CMHC experience preferred
- Previous medical billing preferred
Technical Skills: Strong computer skills to include proficiency with Microsoft Office Suite (i.e. MS Word, Excel and Access). The ability to research and analyze various types of data information. Ability to use standard office equipment such as copy/fax machines and printers.
LANGUAGE SKILLS
Ability to respond to common inquiries or complaints from clients or staff as associated to billing. Ability to communicate effectively with agency employees. Ability to communicate and work effectively, both orally and in writing.
MATHEMATICAL SKILLS
Ability to calculate figures and amounts using basic math skills.
REASONING ABILITY
Ability to prioritize and complete tasks with minimal supervision and demonstrate excellent organizational skills. Strong analytical and problem-solving skills. Must have the ability to make recommendations to effectively resolve problems or issues, by using judgment that is consistent with standards, practices, policies, procedures, regulation or government law. Ability to multi-task, prioritize and to meet critical deadlines on a continuing basis. Ability to work cooperatively and collaboratively with others in order to achieve expected outcomes.
