Billing Specialist

Description

The Billing Specialist is responsible for ensuring Valley View Health Center (VVHC) claims are accurately submitted, processed, posted, and resolved in a timely manner. This role manages all aspects of medical billing on behalf of VVHC, including claim submission, denial follow-up, payment posting, accounts receivable management, and patient billing support. The Billing Specialist plays a critical role in maintaining cash flow, billing compliance, and positive patient financial experiences.
Claims Processing, Billing, and Accounts Receivable

Estimated Effort: 98%

• Provide excellent customer service by assisting patients in understanding billing statements, charges, insurance coverage, and payment responsibilities, including establishing payment arrangements as needed.
• Work directly with insurance companies, providers, and patients to ensure claims are processed and paid accurately and timely.
• Submit claims electronically through the current practice management system and clearinghouse.
• Correct and resubmit any rejected or denied claims by the end of the following business day whenever possible.
• Ensure all claims are submitted accurately and within required timeframes.
• Follow up on claim denials and rework or resubmit claims as necessary to ensure proper reimbursement.
• Maintain accurate accounts receivable records, including logging payments from insurance companies and patients and maintaining current balances.
• Monitor aging accounts receivable and prioritize follow-up on claims reaching 30 days or older.
• Verify insurance eligibility and rebill insurance companies as required.
• Reconcile remittance advices and scan Explanation of Benefits (EOBs).
• Process employee deductions on a bi-weekly basis as assigned.
• Assist in preparing documentation for refunds to patients or insurance companies.
• Generate and mail patient statements according to established billing cycles and procedures.

Collaboration and Support

Estimated Effort: 2%

• Attend meetings, conferences, and training related to billing, claims processing, and revenue cycle operations and share relevant information with appropriate staff.
• Serve as a representative of the Fiscal Department on assigned CAC committees.
• Assist with tasks that support the organization's mission, vision, and values.
• Serve as a backup for Medical and Dental Patient Access Representatives as needed.

Minimum Requirements

Education:
High School Diploma or equivalent.

Job-Related Experience:

• Minimum of six (6) months of training with a computer and bookkeeping background
• At least one (1) year of experience working in a medical billing setting
• Minimum of one (1) year of experience operating personal computers
• Typing speed of 30 keystrokes per three (3) minutes with a maximum of three (3) errors

Preferred Qualifications

• Experience working in a Federally Qualified Health Center (FQHC) setting

Working Conditions

This position operates in a well-lighted office environment. Occasional local or regional travel may be required for meetings, conferences, or training sessions. Work is fast-paced and deadline-driven and involves managing multiple priorities. The role generally involves low-to-moderate levels of stress.