Program Billing Specialist

Position: Program Billing Specialist
Exemption Status: Non-Exempt
Reporting Relationship: Manager, Revenue Cycle Management
Direct Reports: None
Work Environment: Office-Based

Position Summary

The Program Billing Specialist works with the clinical staff and managers of assigned programs to ensure services are authorized, documented, billed, and paid in a timely and effective manner. Maintains a cooperative relationship with all staff to ensure the best service is provided to the agency and acts as the point of contact for the clinical staff for assigned programs for any billing-related questions, problems, or data requests related to the assigned programs.

Essential Duties and Responsibilities

1. Enters billing data from clinical documentation to generate accurate billing charges in accordance with funding source requirements.
2. Reviews and verifies incoming clinical documentation for completeness, accuracy, and compliance with timeliness and payer-specific standards.
3. Collaborates with manager/supervisor to ensure electronic billing charges and corrections are completed timely to support maximum reimbursement.
4. Researches insurance claim denials, determines claim validity, and adjusts and resubmits claims through appropriate submission methods when warranted.
5. Inputs and maintains billing-related data in billing systems in accordance with established procedures and controls.
6. Maintains required performance data and billing and collections metrics.
7. Ensures eligibility and billing exceptions identified in the 271 eligibility file and 837 billing file are corrected and updated in the billing system in a timely manner; follows up with clinical staff to resolve data issues prior to the next billing cycle.
8. Proactively identifies, prevents, and assists in correcting CDC errors in PICIS, and supports staff in determining CDC status and appropriate corrective actions.
9. Proactively ensures all required eligibility information is obtained and updated timely to support accurate billing and maximum reimbursement; communicates barriers to timely and accurate billing to appropriate management.
10. Responsible for staying knowledgeable about and adhering to HIPAA regulations as well as other state, federal, and agency regulations related to confidentiality of consumer health information.
11. Performs other duties as required and/or assigned by supervisor and/or executive staff.
12. Responsible for notifying supervisors of any training deficiencies that impair the PBS's ability to perform their duties.

Education

• High school diploma or equivalent required.

Experience

• Minimum of one (1) year of responsible administrative experience and knowledge Medicare and Medicaid billing required.

• Ability to organize and manage large volumes of documentation.

• Ability to comprehend and interpret verbal and written instructions.

• Must complete all required NorthCare training within 30 days of employment.

• Must have a current TB test within 12 months prior to employment or obtain one within 30 days of employment.

Technical Skills

• Proficient in Microsoft Office Suite or equivalent software.

• Intermediate computer skills.

• Regularly monitors and responds promptly to agency email and voicemail.

Communication & Interpersonal Skills

• Excellent verbal and written communication skills.

• Strong interpersonal skills with the ability to work effectively with employees at all levels.

• Ability to collaborate professionally with diverse staff and stakeholders.

Physical Requirements

• Ability to sit for extended periods while working at a computer.

• Ability to bend, stoop, climb stairs, and move freely throughout facilities.

• Ability to reach upward and downward for filing.

• Finger dexterity sufficient for keyboarding and other administrative tasks.