Billing Specialist II

JOB SUMMARY: The Billing Specialist is responsible for all aspects of billing inpatient and outpatient claims. The Billing Specialist, a key position in the Revenue Cycle, facilitates the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues.

Work is typically performed in an office environment, but this position has the option to work from home with participation in customer/community services activities as needed. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

REPORTING RELATIONSHIPS

The position reports to the Billing Manager. No staff report to this position.

JOB DUTIES AND ESSENTIAL FUNCTIONS
• Prepares and submits clean claims to third party payers either electronically or by paper
• Follows billing guidelines and legal requirements to ensure compliance with federal and state regulations
• Respond to account inquiries from patients, payers, providers, and/or other staff as requested
• Identifies and resolves patient/insurance billing issues
• Work closely with team members regarding claim appeals, denials, resolution, and education
• Performs and monitors all steps in the billing processes to ensure maximum reimbursement from patients, government, and commercial payers as well as from special billing arrangements
• Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Updates business office staff, clinics, residents, and faculty of changes as appropriate
• Responsible for ensuring all new providers are oriented to coding, billing, and documentation compliance
• Responsible for the continuing coding, billing, and documentation education for all providers and residents
• Use online healthcare databases and other resources for verification and claim status
• Deliver the highest quality service to internal and external customers
• Assist other members of the team with projects as needed
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
• Other duties as assigned by management
• Adhere to the Mission and Values of MNHC

QUALIFICATIONS
• High School Diploma/GED with minimum 3 years billing experience
• Must have strong knowledge of all guidelines for ICD-10, CPT/HCPCS codes, medical terminology, and billing processes
• Knowledge of Medical Billing/EHR (Electronic Health Records) systems preferably Medent
• Knowledge of EOBs, EFTs and ERAs
• Knowledge of Microsoft Office software
• Must be focused, self-directed, organized, and have demonstrated problem-solving abilities
• Accurate and precise attention to detail
• Excellent verbal and written communication skills
• Able to work both independently and as part of a team
• Must possess team leadership skills and have a positive disposition

REQUIRED QUALIFICATIONS
• FQHC Billing
• Certified Professional Coder or equivalent experience in years

- Medical, Dental and Behavioral health coding experience required

PACE CARD Metrics
• All I/P accounts will be billed within 21 days from the date the chart is completed by physician.
• All residents receive coding education prior to mid-terms.
• Average AR days greater than 120 days are less than or = 15% of total receivables.
• Overall Average AR days are less than or = 35 days.
• Reduce the number of timely files denials to less than or equal to 1% of gross I/P charges as tracked by adjustment code

PHYSICAL DEMANDS: The physical demands described herein are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, talk, and hear, use hands to finger, handle or feel. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee is frequently required to lift and/or move up to 20 pounds.

The special vision requirements for this job are close vision (clear vision at 20 inches or less), color vision (ability to identify and distinguish colors).

WORK ENVIRONMENT: The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions for this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

MedNorth Health Center provides comprehensive health care services, inside a multi-cultural medical/dental clinic, to all individuals; insured, uninsured, and underinsured. The building is heated in winter and air conditioned in the summer with noise levels of moderate to loud. We serve patients who speak multiple languages and who may need the assistance of an interpreter. In this position one may be subject to exposure to copier toner, correction fluid, bright fluorescent lighting, and continuous personal computer exposure.

This job is a Blood borne Pathogen's risk category I position.

GENERAL EXPECTATIONS:

The employee is expected to attend work on a daily basis and to be at work on time.

The employee is expected to be a team player.

The employee is expected to report absences in accordance with personnel policies and procedures.

The employee's work is expected to be accurate, neat, and thorough, and completed on time.

The employee is expected to have a positive attitude, be cooperative, and considerate of others.

The employee is expected to be dependable and is expected to accept responsibility for assignments and duties given.

The employee is expected to dress and act in a professional manner and to adhere to all safety standards.

The employee is expected to participate in staff meetings, be courteous and polite with patients and other staff.

The employee is expected to maintain confidentiality.