Billing Specialist II

POSITION SUMMARY

As a member of the Finance team, the Billing Specialist II will be accountable for the claim balance of specifically assigned accounts. Duties will include obtaining payor authorizations, ensuring proper claim and modifier coding, communicating with Fora clinical staff and insurance companies to identify and solve issues, resubmitting and adjudicating denied and rejected claims, and applying payments as needed within the electronic health record system and web-based clearinghouse. 

This role will report directly to the Contracts and Billing Supervisor. 

ESSENTIAL JOB FUNCTIONS

• Process timely and accurate authorizations for patient services.
• Ensure claims are processed timely and with correct data points. 
• Support identification of issues and implementation of corrective actions/process changes. 
• Manage the Accounts Receivable aging to ensure outstanding balances are rectified in timely manner.
• Identify basis for denied claims, develop and communicate internal and/or external corrective actions, and resubmit claims where appropriate.
• Apply payments to clients’ accounts in a timely manner adhering to the month end cutoffs.
• Develop client statements and upon clinician request communicate client balance in a timely manner.
• Complete billing audits as required
• Participate in ad-hoc projects related to billings, collections or denials.
• Participate in billing and/or intake related meetings as necessary and offer advice/perspective as it relates to billings and authorizations.

SUPERVISORY FUNCTIONS

This position does not have supervisory duties.

QUALIFICATIONS

EDUCATION AND EXPERIENCE REQUIRED

• At least 3 years billing experience in a medical field 
• Coding certification
• Electronic Health Record systems
• Billing Clearinghouse knowledge
• Calling and/or inquiring electronically with insurance companies to assess claim status
• Payer Knowledge
• Diagnosis, billing codes and modifiers
• Account receivable aging 
• Appeals knowledge and ability to write and get documentation from clinical

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

• Advanced knowledge of coding, modifier usage and denial reason codes
• Proficient in Microsoft Office applications, especially Excel
• Proficient in web-based insurance portals and billing clearinghouses
• Proficient in electronic health systems
• High level of verbal and written communication skills
• Strong organizational skills and attention to detail
• Ability to maintain confidentiality of sensitive information and documents
• Proven ability to prioritize responsibilities to ensure that they are completed in a timely manner

OTHER REQUIREMENTS

• For employees with a history of substance use disorder, Fora Health’s policy requires certification of a minimum of two years of sobriety for this position.
• Ability to pass a pre-employment or for cause drug tests.
• Ability to pass DHS criminal background.
• Position will require some amount of regular connection to work via cell phone to answer questions and respond to internal and external contacts.

WORKING CONDITIONS 

This position has the potential to work remotely after the initial 90 days and upon supervisor’s approval.