Billing Specialist

General Description          

The Billing Specialist is responsible for providing support to the Revenue Cycle Department. This position manages a very high volume of claims and must work quickly and efficiently to manage the consistent flow of work. This position may also serve as a primary subject matter resource for residential billing.  

Tasks & Responsibilities 

A. Essential Duties

• Generates insurance claims and collects outstanding insurance balances. 
• Prepare and submit accurate OON claims for residential behavioral health services (Residential Billing only). 
• Submits appeals and reconsiderations to insurance companies. 
• Makes follow-up calls to the insurance companies on accounts with outstanding balances. 
• Maintains standards to ensure systematic, consistent, and timely collection follow-up.
• If claims are denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database. 
• Ensure medical records needed for billing purposes are in client’s charts and/or submitted. 
• Completes all payer rejections in a timely manner in accordance with department standards. 
• Identifies, separates, and mails claims that require paper submissions for timely submission. 
• Monitors provider enrollments to assure that claims process correctly to ensure timely reimbursements. 
• Reviews, researches, and amends correspondence/explanation of benefits and makes appropriate adjustments to accounts. 
• Identifies and communicates possible system and reimbursement problems to facilitate an efficient and accurate review of the payers. 
• Meets billing compliance standards. 
• Contact insurance carriers to have claims reprocessed in accordance with contracts and plan benefits. 
• Protects Facility value by keeping collection information confidential. 
• Update job knowledge by participating in continuing education opportunities. 
• Review billing reports identify areas that need attention. 
• Provide supervisor with follow up from billing reports. 
• Bi-weekly supervision.

B. Additional Duties 

• Assists and covers other staff when necessary to maintain high productivity and efficiency in the department.  
• As the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.  

C. Interpersonal Relations

• Create Meaningful Connections: Demonstrates ability to function effectively as a part of team. Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.   
• Take Accountability: Take constructive feedback and prevent discourse among our peers. 
• Live in the Solution: Critically thinking should be the solution when problems arise. Having the ability to accepts constructive criticism well in an open and non-defensive manner.  
• Be Professional: Wear business casual attire (please see dress code policy).

Competencies

• Adaptability 
• Customer Service 
• Decision Making 
• Dependability 
• Ethics 
• Interpersonal Skills 
• Job Knowledge 
• Conflict Management
• Organization Skills 
• Productivity 
• Self Development 
• Teamwork

Performance Standards & Measurement

• Compliance with essential and incidental duties; compliance with company policies and procedures.   
• Compliance with state and federal laws and regulations applicable to the business.  

Equipment, Tools & Machines

• Use of computer, telephone, and other office equipment such as a printer and fax.  
• Use of company network and email domain.  

Working Conditions

• Air conditioned and well-illuminated office environment and outdoor environment.  
• May have several responsibilities at once.  Interaction with others is constant and can be interruptive.   
• Work may be stressful at times due to high level workflow. 
• Availability to work flexible hours including weekends, holidays, and evenings as is required to comply with the purpose of the job and accommodate client needs.  
• Participates in educational training, orientations, or compliance programs as needed to maintain competency.  
• If you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.

Demands  

• Enthusiastic self-starter operating with sustained energy and showing great initiative. 
• Comfort working with a diverse base of support, including members, employers, providers, colleagues, community leaders, volunteers, non-profit organizations, vendors, etc.  
• Excellent interpersonal and communication skills, including ability to read, write, spell in English legibly and without excessive grammatical or communication errors.  
• Talk and hear both by person and by telephone; ability to speak clearly and effectively using proper grammar before patients, employees and business partners, among others.  
• Excellent organizational skills.  
• Accepts constructive criticism well in an open and non-defensive manner.  
• Ability to manage conflicting priorities.  Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.   
• Ability to function independently and with flexibility.  
• Ability to work under pressure, handle multiple tasks and interruptions.   
• Occasional lifting of moderately heavy office supplies; ability to lift supplies for community events, trade shows, conferences, and other marketing opportunities applicable to the organization; ability to lift, push or pull up to 25lbs.  
• Ability to sit, stand, or walk for extended periods of time. 
• Must have strong computer skills to meet Microsoft Office and Electronic Health Record software requirements.  

Qualifications

Education

• High School Diploma or equivalent; Billing and Coding Certification from one of the following national certification exams: 
• American Medical Billing Association - Certified Medical Reimbursement Specialist (CRMS) Board Exam 
• AAPC - Certified Professional Coder's (CPC®,) Certified Outpatient Coder (or CPC-HCOC™) [formerly CPC-H®,] Certified Inpatient Coder (CIC™,) or Certified Professional Medical Auditor (CPMA®) Board Exam 
• American Health Information Management Association - Certified Coding Associate (CCA®,) Certified Coding Specialist (CCS®,) or Certified Coding Specialist Physician-Based (CCS or CCS-P®) Board Exam - The CCS & CCS-P credentials require experience in addition to the education 

Experience:

• Billing and Coding: Minimum of 1 year  
• CPT and ICD coding
• Computer literate: Microsoft Office (Excel, Word, and PowerPoint) required.