Benefit & Collection Specialist - Agency Admin

Benefit & Collection Specialist

Enjoy making a difference? Join the team at Family Residences and Essential Enterprises, Inc. (FREE), enriching the lives of others, one individual at a time. FREE benefits and proudly supports more than 4,000 individuals with intellectual/developmental disabilities, mental illness and traumatic brain injury. It is the mission of FREE to support people of all abilities reach their full potential and thrive in their communities. FREE provides a diverse array of supports and services including: housing; recovery services; transition to work; employment; day, community and family services; respite; crisis services; education and after school support; specialty health services; and advocacy.

Position Summary

The primary role of the Benefit & Collection Specialist, under the supervision of the Billing Manager, is to facilitate efficient operations in insurance eligibility, authorization, and collections follow-up for FREE and the FREE Family Network.

Duties, Responsibilities, and Essential Functions

• Monitors and tracks the eligibility status of all individuals enrolled in the Behavioral Health programs and ensures timely communication to operations staff in the programs where individuals are within 90 days of benefit recertification.
• Assists operations staff to contact the appropriate parties to facilitate the recertification process, as needed.
• Follows up with operations and tracks the status of the recertification process to ensure all recertifications are completed within the behavioral health regulations.
• Assists in the review of behavioral health billing for accuracy and completeness prior to submitting billing, including prompt follow-up on any missing or incomplete billing, as needed.
• Communicates proper coding and billing to operations teams as needed.
• Reviews aging reports to ensure timely collections are being received.
• Communicates past due balances to responsible parties for timely resolution.
• Documents unresolved issues and presents to Billing Manager for additional follow-up.
• Follows up on unpaid claims within standard billing cycle timeframe.
• Researches denied and/or partial paid claims; reviewing all documentation and correspondence related to the claim, to properly determine the best course of follow-up.
• Documents all communications on denied or partial paid claims, including name, date and time of person spoken to, case number, and/or reference number as available.
• Files appeals for all denied and/or partial paid claims; follows up on appeals to ensure they are processed timely, and payments are received.
• Notifies Billing Manager immediately of any issues in the billing process that lead to non-payment by a payor, such as incorrect codes or patient data.
• Works on special projects; assist in office operations as needed.
• Ensures that all required documentation (paper and electronic) is completed/processed appropriately, in a timely manner, and meets quality and compliance thresholds.
• Perform other duties as assigned

Responsibilities of All FREE Employees

• Always communicate in a respectful manner with all people including the people we support, supervisors, other valued team members, and members of the community.
• To comply fully with FREE's confidentiality policies by holding in strictest confidence all information pertaining to members, residents, the people we support and their families, clients, providers, contractors, and employees.
• Meets all safety training requirements; adheres to all safety policies and reports any and all unsafe conditions; takes measures to prevent accidents and/or eliminate conditions that pose a safety or health risk.
• Coordinates, supports, attends and participates in all required events/ meetings/ reviews/ committees, including ones outside of standard working hours.
• Meets all job requirements and stays in compliance.
• Adheres to FREE's standard of ethical behavior as outlined in the Employee Handbook and Code of Conduct as well as applicable laws and regulations.

Please note the above duties, responsibilities, and essential functions are a non-exhaustive list, and may be changed by FREE at any time, with or without notice to the employee.

Qualifications

• Education: High school diploma or equivalent required; bachelor's degree in business, healthcare administration, accounting, or related field preferred.
• Experience: Experience with medical billing and collections is preferred.
• Specialized Training, Licenses, Certifications: Not required, training will be provided upon hire as needed
• Knowledge, Skills, Competencies, and Abilities: Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payor requirements and systems is preferred. Familiarity with CPT and ICD-10 coding and medical terminology is preferred. Familiar with Electronic Health Record (EHR) systems. Proficient with Microsoft Office Suite, especially Excel. Demonstrated ability to work in a team environment with flexibility, keeping others informed and anticipating needs is essential. Must be efficient, detail oriented, well organized, and have excellent written and verbal communication skills.
• Other Requirements: None required.

Work Environment

This role is performed in-person in a standard office environment.

Physical Requirements

• Position is sedentary; employee is required to sit for prolonged periods of time (up to 8 hours)
• Employee is required to effectively communicate both verbally and in writing
• Employee is required to operate standard office equipment such as computers, phones, photocopiers, fax and filing cabinets
• Employee might be required to lift, bend, or move light items
• Employee is required to reach with hands and arms.

Notwithstanding the above listed physical requirements of this position, FREE will provide reasonable accommodations to allow employees to perform the essential functions of the position, provided such reasonable accommodations do not cause undue hardship on FREE.

FREE is an equal opportunity employer and provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, gender identity, sexual orientation, national origin, age, disability, genetics, or any other protected characteristic. In addition to federal law requirements, FREE complies with applicable state and local laws governing non-discrimination in employment in all of its locations. This policy applies to all terms and conditions of employment, including, but not limited to, recruiting, hiring, placement, promotion, termination, recall, transfer, leaves of absence, compensation, and training.

Family Residences and Essential Enterprises