Accounts Receivable Billing Specialist

Medical Billing Specialist

Under the direct supervision of the Director of A/R, the Medical Billing Specialist is responsible for processing timely, complete and accurate billing information in compliance with government and third party payers to insure prompt and accurate reimbursement.

Essential Duties

1. Prepare, review and process healthcare claims to the clearinghouse for the Managed Care Organizations (MCOs), Medicaid, Medicare and commercial insurance companies using billing software.
2. Entering claims using CPT, ICD-10 codes and other medical terminology.
3. Meet coding deadlines to expedite the billing process.
4. Review all insurance payments for accuracy and compliance with the contract discount.
5. Following up on unpaid claims within the standard billing cycle.
6. Identify, research, resolve and/or appeal denials, exceptions and exclusions.
7. Manage patient and insurance inquires.
8. Maintain records of medical billing.
9. Validate eligibility, benefits, deductibles and produces accurate documentation.
10. Assist in the development and implementation of operational improvements.
11. Continuously learn about healthcare coverage options and benefit plans.
12. Communicate with management of payer trends identified.
13. Enter payment posting and adjustments.
14. Contribute to the development and maintenance of the Agency's systems through the timely completion of assigned documentation and in accordance with applicable legal, fiscal, licensing and accreditation regulations and standards.
15. Maintain current knowledge and skills through reading and utilizing coding resources. Attends and participates in coding education systems.
16. Respect the privacy of clients. All client material should be handled in accordance with Agency guidelines on confidential material.
17. Ad-hoc analysis and reporting as necessary.
18. Other duties as assigned by management.

Other Duties

1. Attend scheduled staff meetings, supervision, and on-going training.
2. All required trainings, certifications and licensure must be kept current in accordance with applicable licensing and accreditation regulations and standards.
3. Maintain high standards of ethical and professional conduct and adhere to Agency policies and procedures.
4. Other duties as assigned by management.

Qualifications

1. Education: Associates Degree preferred.
2. Licensure/Certification: Medical coding certification preferred
3. Competency/Skills:
   • Core Expertise: Possess skill, knowledge and abilities to perform the essential duties of their role; keeps knowledge up to date.
   • Independent Judgment: Demonstrate ability to perform job responsibilities with a high degree of initiative and independent judgment.
   • Cultural Competency: Demonstrate awareness, sensitivity and skills in working professionally with diverse individuals, groups and communities who represent various cultural and personal background and characteristics.
   • Interpersonal Communication: Communicate clearly using verbal, nonverbal, and written skills in a professional context; demonstrates clear understanding and use of professional language.
   • Professional & Ethical Conduct: Adhere to professional values such as honesty, personal responsibility, and accountability; Applies ethical concepts within scope of work and adheres to Agency policies and procedures.
   • Collaboration and Teamwork: Function effectively as a member of a professional team that includes employees, clients and family members.
   • Problem Solving & Decision Making: Recognize problems and responds appropriately; gathers information and sorts through it to identify and address root cause issues; makes timely decisions.
   • Service Orientation: Anticipate, recognize, and meet the needs of others, whether they are clients or not. Technical Proficiency: Demonstrate competence in utilizing Agency computer systems and software as required to perform essential job functions.
4. Experience:
   • 3-5 years related experience and/or training required.
   • Demonstrated accounts receivable and collection skills.

Wingspan Care Group ("Wingspan") is the not-for-profit parent company of Applewood Centers, Inc., Bellefaire Jewish Children's Bureau, Bluestone Child & Adolescent Psychiatric Hospital, and Lifeworks. The mission of Wingspan is to provide organizational efficiencies at the operational, administrative, and fiscal levels for its subsidiary agencies so that they may focus on their respective missions. Wingspan is an Equal Opportunity Employer. Wingspan's policy is not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information, or any other basis protected by applicable federal, state, or local laws. Wingspan also prohibits harassment of applicants or employees based on any of these protected categories.