Medical Billing Specialist ; Ohio-Based

Zepf Center has been serving the Lucas County community for over 50 years. We are the leading provider of behavioral health and substance use disorder services in Northwest Ohio. Services include adult and child psychiatric, substance abuse, case management, residential, Crisis Care, and therapy programs, as well as career development and wellness services. Zepf Center also offers primary care medical services to our patients to contribute to their continuum of care. Zepf Center is a trauma-informed agency and environment for both patients and staff.

We are currently seeking a full-time Medical Billing Specialist. The purpose of this position is to perform the various activities related to billing and collection of open receivables and accurate and timely posting into billing system to ensure maximum payment and integrity of client ledgers. The position will perform the entry, submission and processing of patient and insurance information including claims, payments, and denial management, serve as agency contact for billing related questions and provide back-up support to other members of the Billing Department. This position is responsible for performance of billing activities required to ensure maximization of payment from assigned payer sources. The work is varied, requires high attention to detail and strong mathematical, analytical and problem-solving skills.

Essential Duties and Responsibilities:

• Complete billing-related tasks to include review and updates of patient insurance information, COB order, and reallocations of balances as necessary to ensure billing to the correct coverage plan.
• Prepare 837 EDI claim files and upload or forward them electronically for payment.
• Retrieve 835 remittance files and upload them into the billing system.
• Post payments & adjustments (manually & electronically) to individual client ledgers.
• Review payment and adjustment amounts for accuracy while posting and note discrepancies.
• Ensure all postings and payments are tied exactly to A/R ledgers via detailed reconciliation of EOBs, deposits, and posting.
• Immediately work denials, rejections, under or overpayments during and after posting, and perform follow-up to ensure accurate and timely payment. This work may be done in the electronic health record (EHR) billing system, the clearinghouse, or on the payer website or portal.
• Process all submissions and/or resubmissions of claims & corrections via the EHR, payer portal, or clearinghouse as appropriate. Monitor and perform follow-up.
• Prepare and send documents as required for payment, refunds, or plan updates.
• On an ongoing basis, monitor and perform research and resolution of all remaining accounts receivables that are unpaid, underpaid, or overpaid. Work unresolved denials, resubmit, and perform follow-up as necessary to prevent aging AR.
• Communicate any claims issues with contacts at assigned payers and involve management as appropriate.
• Review and verify client eligibility for insurance as needed. Update the billing system to reflect accurate dates and status.
• Respond to patient or other staff phone calls, investigate inquiries, and respond accordingly. Involve management as necessary.
• Serve as backup and support to other fiscal and A/R staff.
• Carry out policies and procedures of the agency; may participate in community work, staff development, and agency-wide projects; serve on agency committees/teams, attend meetings, and perform other miscellaneous duties as requested.

Specific/Individual Competencies:

• High degree of numeric data entry and mathematical calculations involved.
• Requires attention to detail, strong organizational skills, problem solving skills and self-initiated follow-up.
• Professional approach to all functions and relationships with all levels of staff, clients, other agencies, and the public.
• Abide by agency and professional code of ethics.
• Strive to continuously improve own and agency operations.
• Incorporate CQI into daily work activities.

Organizational Competencies:

• Demonstrate knowledge of the agency’s mission, vision, goals, philosophy, policies, and procedures.
• Strive for high client satisfaction by providing leadership and/or assistance to coworkers and clients through the work process.
• Demonstrate consistent professionalism.
• Demonstrate teamwork.
• Abide by the agencies and/or professional code of ethics.

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