Billing Specialist

OPEN UNTIL FILLED

JOB SUMMARY:

Perform and execute key tasks within the revenue cycle to ensure collection of revenue.  This includes review of all billable services for accuracy and quality assurance, submission of initial billing, and continued follow-up completing the revenue cycle.  The Billing Specialist works collaboratively with direct care, administrative staff, and payers to properly complete every aspect of payment and collections.  Identify revenue cycle issues and trends reporting these to Reimbursement Manager.

ESSENTIAL FUNCTIONS: 

1. Upon notification, review the service authorization/registration request for quality assurance purposes prior to submission, for missing, incomplete, or incorrect data.  If needed, communicate with program staff to update information such as demographic or diagnostic elements.  Submit authorization requests to appropriate payer through payer websites, phone, or fax.  Determine status of submitted authorization requests and follow up by communicating with staff on denials or pends.  Set up approved authorization in electronic health record managed care section.
2. Examine and analyze reports for quality assurance and accuracy of data, including demographic, diagnostic, eligibility, and staff credentialing to maximize revenue collection.  Utilize pre-billing reports to locate billing errors, lapsed authorizations, incomplete services, etc.  Collaborate with the Revenue Cycle Specialist, as necessary, to identify changes needed to improve work flow processes based on assessment of findings and trends.
3. Review claims via clearinghouse, payer portal, or paper remittance to ensure accurate processing of individual accounts, and pursue claims with unpaid balances, pending status, or denials.  Identify reason for non-payment, make corrections to claim, if applicable, and resubmit for billing.  If determined that claim is not payable, submit adjustment request based upon the appropriate reason. 
4. Submit claims in accordance with billing schedules and consistent with specific payers requirements to ensure successful and timely remittance.  Track and review batch submissions to ensure completion of revenue cycle, and report billing data to the Revenue Cycle Specialist and the Reimbursement Manager.
5. Verify eligibility of coverage and benefits for insurances such as Medicaid, Medicare, managed care entities, and other commercial insurances, etc., to determine authorization and specific provider requirements.  Maintain access to all necessary payer websites and portals.   Establish payer in the electronic health record to ensure proper priorities, and communicate with staff any additional needs or requirements for authorization and billing.
6. Process and generate monthly statements for individuals with a balance due.  Collaborate with program staff to update demographic information in the electronic health record as necessary, in response to returned mail.  Manage bankruptcy notifications by notifying program areas, filing documentation, and making necessary adjustments to account.  Respond to requests from individuals regarding account balances according to agency procedure for collections.
7. Maintain knowledge and skills pertaining to revenue cycle management, including webinars, conferences, payer-initiated trainings, and applicable meetings.  The Billing Specialist must maintain knowledge of payer requirements by reviewing current memos, manuals, email updates, and payer trainings.

OTHER DUTIES: 

• When requested, serve on agency committee dealing with billing and other reimbursement issues.
• Perform other job-related tasks as assigned by supervisor.

QUALIFICATIONS:

• Good oral and written communication skills.
• Understand and comply with policies and procedures.
• Work independently and perform multiple tasks.
• Must be able to develop and maintain professional, service-oriented working relationships with individuals, providers, co-workers, supervisors, and payer customer service representatives.
• Knowledge and skill of agency electronic health record system.
• Knowledge and ability to navigate and perform work duties within multiple databases and portals.

EXPERIENCE/EDUCATION REQUIRED:

Bachelor's degree or equivalent reimbursement experience or a combination of education and experience to total four years.