Billing Specialist

Position Summary:

This position exists to assist and support the Billing Department in all billing functions deemed appropriate by the Billing Administrator and Coding Specialist.  Each individual employee within the Billing Department will be responsible for a specified subset of the Key Responsibilities listed below. 

Key Responsibilities:

• Meets with all individuals prior to the first appointment and completes all necessary financial paperwork.
• Meets with individuals to update financial information as needed.
• Applied Medicaid and board funding payments on the billing software application system.  Adjusts these accounts when needed.
• Applies insurance payments on the billing software application system. Adjusts these accounts when needed.
• Applies client payments on the billing software application system. Adjust these accounts when needed. This includes approving all support cash sheets for client payments.
• Processes insurance denials and performs associated follow-up within 30 days.  All insurance claims not responded to within 45 days after being sent will be followed up and proper action will be taken to receive payment.
• Communicates by telephone with insurance companies; handles incoming calls and inquiries.
• Performs customer service functions; handles telephone inquiries and processes client communications.
• Tracks all board funding enrollments and claims. Tracks all critical and non-critical errors
• Processes all incoming fax and online correspondence.
• Creates weekly credit card deposit log.
• Tracks and submits all necessary prior authorizations as required by Medicaid plans.
• Provides back-up coverage for maintaining staff CAQH database for all necessary providers.
• Provides back-up coverage for maintaining provider records within PNM system for Medicaid providers.
• Provides back-up coverage for all credentialing applications for eligible providers with third party payers.
• Provides back-up coverage for completing all agency contracts for Medicaid, Medicare, and third-party payers.
• Other job duties as assigned

Minimum Qualifications:

• Education:           High school diploma or equivalent          
• Certification:      N/A       
• Other:                  

Knowledge, Skills, & Abilities:

Knowledge of:   Administrative and clerical procedures and systems, such as data entry, word processing, spreadsheets, managing files and records, office procedures and terminology; arithmetic and its application; principles and processes for providing customer service; Safety rules and procedures; Agency policies and procedures.

Skills:                    

• Capacity to perform duties effectively under potential emotional stress and conflict situations.
• Proficiency in utilizing basic computer skills and office equipment for documentation and communication purposes.
• Practice of a client-focused approach, demonstrating active listening skills, reading comprehension, critical thinking, and leadership abilities.

Abilities:

• Willingness and physical capability to engage in activities essential to meet the fundamental needs of individuals served. This includes occasional assistance in relocating individuals to new living situations, aiding with shopping, and instructing daily living skills, as necessary.