Billing Specialist

Billing Specialist

The Billing Specialist enters all client billing in Thom Billing Revised (TBR) and is responsible for the overall billing process in adherence to MassHealth and all other insurers' billing procedures as directed by DPH Billing Manual and Thom Billing Manual. Serves as back to other Billing Specialists.

Specific Job Duties and Responsibilities:

• Coordinates activities with other EI Billing Specialist in the Framingham office.
• Maintains a collaborative relationship with program office and other Thom offices.
• Works collaboratively with other Thom Billing Specialists, both at the administrative office and at offsite locations.
• Works collaboratively with program staff including service providers Insurance Coordinator to complete weekly billing process.
• Demonstrates knowledge of all aspects of TBR and TC.
• Maintains meticulous records of all communication regarding claim payment, including call logs and email communication.
• Adheres to MassHealth and all other insurers' billing procedures as directed by DPH Billing Manual and Thom Billing Manual.
• Ensures that all activity sheets have been submitted by service providers on a weekly basis.
• Reviews activity sheets for completeness on a weekly basis including verifying that a case note is available for each service listed on the Activity Sheets.
• Collaborates with service providers to verify billing questions.
• Completes synchronization of billing data from activity sheets from TC to TBR on a weekly basis in accordance to transmission guidelines and dates.
• Bills, posts payments and follows up on claims for services to private health insurers, MassHealth, and the Massachusetts Department of Public Health.
• Maintains confidentiality of client information pursuant to federal and state regulations and agency policies.
• Ensures client files are properly maintained, stored, secured, and when appropriate, destroyed in compliance with the agency's document retention and destruction policy.
• Assists with record requests from Framingham office and external partners by obtaining necessary documentation from offsite locations as well as from client files stored onsite or stored electronically.
• Assists in administrative duties including copying, filing and keeping office organized as needed. Assists with all general receptionist duties including answering the telephone, taking referrals, typing correspondence.
• Updates and maintains assessment hours information in TC.
• Designs special reports from TBR upon request of the Program Director.
• Updates billing software and data as needed.
• Communicates with Program Director to share updates on any billing-related problems.
• Assists service providers to complete and submit waivers. Enters waiver information into TC.
• Assists with support, orientation, and training of billing codes and rules to service providers.
• Prepares TBR Reports for each clinical staff person.
• Serves as back to other Billing Specialists.
• Other duties as assigned.

Education and Qualifications:

• A minimal educational requirement of a high school diploma or equivalent and be at least 18 years old.
• A minimum of three years administrative experience with strong interpersonal skills, general knowledge of insurance billing, computer literacy, strong organizational skills and the ability to work independently.
• Minimum of one year of experience in medical billing.
• Ability and interest in working with a team of professionals.
• Maintain appropriate professional boundaries; promote client confidentiality; and exhibit flexibility, sensitivity to cultural differences, and teamwork.
• Experience with Microsoft Word and Excel.
• Excellent file management skills.
• Excellent verbal and written communication skills
• Outstanding customer service skills.
• Ability to problem solve, make recommendations, and implement solutions.
• Ability to work flexibly and collaboratively with colleagues and representatives from a variety of stakeholder groups.
• Ability to learn customized software specifically for Early Intervention billing.