Billing Specialist III

Billing Specialist III

Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State. Sea Mar proudly serves all persons without regard to race, ethnicity, immigration status, gender, or sexual orientation, and regardless of ability to pay for services. Sea Mar's network of services includes more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services.

This position is responsible for reviewing and posting charges, resolving failed claims and rejections, posting payments and adjustments, timely processing of secondary insurance, processing denials, bimonthly rebills, following up with insurance companies on accounts not paid, customer service, and collections of private past due accounts. This position is also responsible for ensuring accurate and timely processing of all third-party insurance, Medicaid, and private pay including special programs. Additionally, this position is responsible for training, supporting, and being a back-up for other medical, dental, and behavioral health billing personnel.

Key Responsibilities:

• Import, review and post all medical, dental, and behavioral health charges
• Process all medical, dental, behavioral health, and special programs encounter forms.
• Process all missing encounters
• Adjust sliding fee discounts according to the sliding fee policy
• Process all clean claims and correct and process all failed and rejected claims
• Follow-up with insurance companies on claim correction questions or on outstanding accounts
• Correct and rebill patient accounts billed with the incorrect insurance, plan or no insurance
• Correct all denied claims and rebill using the appropriate method (VRE, Portal, PM, etc.…)
• Follow-up on any mailed Medicare claim returns and paper generated denials
• Import, review and post all payments, adjustments, or transfer of balances
• Assign all unassigned payments and prepayments to the appropriate patient account.
• Process all secondary insurance claims
• Assist patients by answering questions about their account, resolving billing issues, processing payments, and appropriately updating the patient's account
• Scan all paper payment batches and support documentation including EOBs, denials, etc.
• Process all approved credit balances including overpayments made by payers and patients
• Process all approved clinic adjustment requests
• Ensure open batches are closed each day
• Respond timely to billing record requests and billing audit requests
• Run regular reports to ensure all claims are being properly billed and accounted for
• Assist and back-up other business office staff as needed
• Perform other duties and accept other responsibilities as assigned by the immediate supervisor

Qualifications

This position requires a comprehensive understanding of accounts receivable management in a healthcare setting. This position requires strong working knowledge of managed care plans, insurance carriers, referrals and precertification procedures. Also required is a strong working knowledge of CPT, ICD-9, ICD-10, HCPCS, modifiers, coding and documentation guidelines. Strong customer service, organizational and communication skills are essential to this position. In addition, strict adherence to write-off policies, refund policies and other accounts receivable policies as outlined in the Procedure Manual is required. This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment. Also required are general computer skills, typing skills and a working knowledge of Medicare Compliance, OSHA and HIPAA

Sea Mar is an Equal Opportunity Employer and offers a competitive benefits package.

Starting Wage: $22.41 per hour

Work Schedule: Monday - Friday

Hourly - Hourly Plan, 22.41 USD Hourly

What We Offer:

Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization. Working at Sea Mar Community Health Centers is more than just a job, it's a fulfilling career with opportunity for advancement. The fringe benefits surpass most companies. For example, Full-time employees working 30 hours or more, receive an excellent benefit package of:

• Medical
• Dental
• Vision
• Prescription coverage
• Life Insurance
• Long Term Disability
• EAP (Employee Assistance Program)
• Paid-time-off starting at 24 days per year + 10 paid Holidays.
• We also offer 401(k)/Retirement options and an exciting opportunity to work in a culturally diverse environment.

Sea Mar is an equal opportunity employer.