Billing Specialist

Our Mission, Vision, & Model of Care

At Union Community Care, our purpose is at the forefront of all that we do: we stand for whole health to help you live your fullest life.

We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member’s unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.

We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.

We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.

JOB SUMMARY

This position is responsible for a variety of complex clerical and accounting functions related to medical accounts receivable (A/R), including insurance verification, insurance claim submission, along with collection, posting, and managing account payments.  Duties also include following up on submitted claims and patient billing, along with investigating insurance denials. 

SPECIFIC JOB DUTIES- Billing Specialist I

1. Posting of daily charges and research missing slips to make sure all charges are captured
2. Prepares, audits and generates clean claims
3. Processes and posts insurance payments along with patient payments in an accurate and timely manner in accordance with Union Community Care’s policies, procedures and performance goals.
4. Coordinates with PAS to ensure accurate patient information for billing purposes
5. Performs a variety of general clerical duties, including telephone reception, mail distribution, and other routine functions.
6. Works all Claim Holds and Denials by investigating (calling), correcting and resubmitting claims to third party payers
7. Answers questions from team members, patients and insurance companies
8. Identifies and resolves patient billing questions and complaints
9. Knowledge of Sliding Fee policy and rates
10. Maintains patient demographic information, including insurance eligibility and benefit verification
11. Ability to prepare, reviews, and sends patient statements
12. Creates payment plans with patients; that follow the guidelines established by Union Community Care
13. Participates in educational activities and attends staff meetings
14. Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations
15. Performs other work-related duties as assigned
16. Reconciles cash and batches daily
17. Works on appeals to insurance companies as needed

SPECIFIC JOB DUTIES- Billing Specialist II

1. Preform all job duties of Billing Specialist I
2. Demonstrates the ability to act as a coach to peers
3. Proficient in both Medical and Dental Billing

SPECIFIC JOB DUTIES- Billing Team Lead

1. Performs all duties of Billing Specialist I
2. Works with Billing Specialists to research appropriate billing & coding procedures
3. Works with Director of Billing to maximize revenue potential based on our unique services and providers
4. Works with Director of Billing to maximize department efficiency
5. Assists with reconciliation errors
6. Works with Accounting to identify any discrepancies in cash
7. Keeps ongoing knowledge of current CPT/CDT guidelines and educates Billing Specialists
8. Responsible for Training of Billing Staff
9. Assists with Training of PAS
10. Certification in Medical Billing or Coding preferred

JOB REQUIREMENTS

To perform this job successfully, an individual must be able to perform all duties satisfactorily.  The requirements listed below are representative of knowledge, skill, and/or ability required.

1. Knowledge of medical terminology and current CPT AND/OR CDT coding practices preferred
2. Working knowledge of Microsoft Office, EMR software’s and other online programs; along with general business equipment
3. Basic mathematic skills
4. Spanish proficiency preferred
5. Ability to work well with others

ESSENTIAL FUNCTIONS

To fulfill the requirements of this position, all duties above are considered essential functions of the job.

ORGANIZATIONAL INVOLVEMENT

This position is required to participate in mandatory all staff meetings, team meetings and trainings.