Billing Specialist I

JOB SUMMARY:

Responsible for audit of medical, dental, behavioral, and hospital insurance claims for accuracy and timely electronic submission of claims through practice management system. Responsible for follow-up on outstanding claims and for maintaining accurate accounts receivable records in the organization's practice management system.


ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. 1. Audit medical, dental, behavioral, and hospital insurance claims for accuracy and timely submission of insurance claims electronically through practice management system.
   2. Application of insurance and other payments, and all adjustments required for accurate patient accounts receivable records.
   3. Responsible for monitoring the patient accounts receivable aging reports and using the reports to identify accounts requiring attention.
   4. Responsible for staying current with information needed for accurate claims submission to Medicaid, Medicare, CHIP, commercial and other third party payers.
   5. Responsible for staying current with the rules and regulations for all payers and the updates or changes in state and federal regulations, and notifying the appropriate health care services (HCS) and management staff.
   6. Review insurance accounts and request adjustments and/or refunds, as appropriate.
   7. Appeal and/or resubmit denied or rejected insurance claims.
   8. Inform Supervisor of accounts receivable issues, and the potential effect the issues may have on the organization and reimbursements.
   9. Work with HCS staff to stay informed of patient flow through the clinics and provide feedback to HCS supervisory staff of incomplete or incorrect information and/or changes in the requirements affecting billing and collections.
   10. Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
   11. Perform other duties as assigned by supervisor.
   12. Follow Access Health accounts receivable policies and procedures.

EDUCATION/LICENSURE/CERTIFICATION QUALIFICATIONS:

REQUIRED:

1. High school graduate or equivalent.

PREFERRED:

1. Knowledge of all aspects of various billing software programs.
2. Knowledge of medical terminology and coding to include CPT, ICD9, ICD-10 and HCPCS coding
3. Knowledge of medical billing/collection practices.
4. Knowledge of governmental legal and regulatory provisions related to billing activities.
5. Knowledge of payment and adjustment policies and procedures
6. Knowledge of third-party reimbursement terminology, explanations and policies
7. Extensive knowledge of AIR reporting.
8. Ability to read and interpret EOBs in detail.
9. Experience ii training, team building, and customer service.
10. Effective verbal and written communication, organization and interpersonal skills.
11. Ability to interface with all levels of personnel in a professional manner.

SKILLS AND EXPERIENCE:

REQUIRED:

1. Two years of work experience in a medical office environment, to include work with Medicaid, Medicare, managed care organizations, commercial and other third party payers claims submission and appeals.
2. Experience with medical and dental terminology, procedural, and diagnosis coding (ICD, CPT, HCPCS, and CDT).
3. Maintain compliance with HIPAA regulations.
4. Good oral and written communication skills.
5. Ability to deal professionally, courteously and efficiently with the public and all levels of the organization.
6. Ability to handle multiple projects simultaneously.
7. Ability to operate computer, copier, fax, and 10-key machine.
8. Experience with Microsoft Office and practice management system software applications.
9. Basic accounting knowledge.
10. Ability to work with people of all socioeconomic levels.
11. Consumer advocate for quality health care and services.

PREFERRED:

1. Experience in a community health center

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle and feel objects, tools and controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch and crawl; talk and hear; taste and smell. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

WORK ENVIRONMENT:

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is not exposed to weather conditions. The noise level in the work environment is usually moderate.

Hours:

Employees will be assigned to a regular work schedule, which may include hours before 8:00 am, after 5:00 pm, and Saturdays as determined by department needs and requirements. May travel to other AccessHealth sites to provide services as needed.

ACKNOWLEDGEMENT:

It is the responsibility of AccessHealth to provide and emphasize a team approach to patient care. A "team-based" approach to patient care refers to the interactions that occur between multiple individuals who interact and are involved in the patient's care at AccessHealth. As a member of the team-based approach to care, the employee engages in excellent communication among team members in order to develop and provide successful patient-centered care as well as to ensure the necessity for the ongoing coordination of care; team meetings to facilitate discussing the patient's ongoing medical care and needs; training in evidence-based approaches to self-management support, such as patient coaching, motivational interviewing, and concepts of population management and or provision of services for vulnerable populations; and review of patient quality and outcomes and participation in improvement initiatives to provide an opportunity for members of the team to identify and implement improvements.