Billing Specialist

POSITION PURPOSE AND OBJECTIVES

The Billing Specialist is responsible for billing Medicaid, insurance companies and special grants and contracts for all services provided through the agency; maintaining staff credentialing for third-party insurance carriers; and performing other work associated with the billing process.

ESSENTIAL JOB FUNCTIONS

• Benefit Verification - contacts third party payers to verify benefits (mental health and prescription) for clients and forwards information and/or instructions to appropriate personnel.
• Pre-certification - obtain and monitor pre-certifications, authorizations and treatment plans required for clients.
• Billing - claim submission for Medicare, Medicaid, managed care, insurance and other third party payers in accordance with internal and external rules and regulations.
• Posts insurance payments and adjustments in agency computer system according to agency policies.
• Collections - Investigates rejected claims for possible resubmission. Works closely with financial intake staff to obtain needed insurance information from clients, as well as obtaining needed clinical information from staff. Follow up on unresolved claims to insure maximization of revenue sources.
• Verifies completeness and accuracy of all claims prior to submission.
• Ensure all claims are submitted with a goal of zero errors.
• Reading and interpreting insurance explanation of benefits
• Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies.
• Regularly meet with Billing Supervisor to discuss and resolve reimbursement issues or billing obstacles.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

• In order to perform the essential functions of this job, the employee must possess the following:
• A working knowledge of Riveon Mental Health and Recovery Policy and Procedures, including sensitivity to consumers and adherence to clients’ rights, confidentiality, and health and safety issues. Must exhibit sensitivity to different cultures.
• Because a sizable portion of this position requires data entry, good computer skills and accurate typing skills are required.
• Many of the responsibilities have monthly deadlines, so time management and organization skills are crucial.
• Third party billing and pre-certification experience is needed, as well as customer service experience.

WORKING CONDITIONS

• Almost all time is spent in an office environment, currently in an open area shared with other staff, although the employee will have their own work station.
• Position requires considerable phone contact with third party payers, clinical staff and clients, as well as written correspondence and faxing.

REQUIREMENTS/QUALIFICATIONS

• High school diploma or GED with medical specific secondary training required.
• Three to five years recent computerized third party billing experience with a working knowledge of CPT and ICD 10 coding requirements is required. Typing and data entry skills.
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement is required.
• Must have the ability to manage relationships with various insurance payers and have familiarity with medical/ insurance terminology.
• Strong knowledge of Medicare and Medicaid practices is required.
• Must have the ability to multi-task and work courteously and respectfully with fellow employees, clients and patients.