Billing Specialist

The Billing Specialist is responsible for managing accounts receivable, billing, and collection of payments for Medicaid, Medicare, and commercial payers.


DESCRIPTION OF DUTIES

Data entry into the electronic billing system

Preparing and submitting billing data and medical claims to insurance companies.

Verifying consumers' insurance coverage.

Responsible for obtaining insurance Prior Authorizations and referrals for case management, behavioral health, and primary care services.

Preparing, reviewing, and transmitting Medicaid, Medicare, and commercial insurance claims by electronic and/or paper claim processing.

Preparing and submitting claims for Substance Use services.

Following up with insurance companies on unpaid or rejected claims and timely resubmitting claims once issues have been resolved.

Reviewing insurance remittances for billing errors; making necessary corrections, and resubmitting claims.

Posting insurance payments and patient payments using the billing software.

Rectifying delinquent accounts by setting up payment plans and monitoring payments.

Ensuring accuracy and completeness of patient's account balances.

Preparing monthly patient statements.

Reviewing and preparing monthly invoices for school-based services.

Answering consumer and patient questions about account balances and billing.

Generating accountability reports for Carastar staff.

Assisting with the State of Alabama required data uploads.

Providing front desk and call center coverage at any Carastar facility when needed.

Providing coverage for the Disability Determination Specialist when needed.

Participating in educational programs to ensure and enhance job knowledge.

Performing other related duties as requested by Supervisor.

REQUIREMENTS

Knowledge of Medicaid, Medicare, and commercial billing.

Knowledge of insurance processes, procedures, and diagnosis coding (CPT/ICD-10).


Experience with electronic and paper billing medical claims.

Proficient experience in Microsoft Excel, Word, and Outlook.

Experience with medical billing software application systems and electronic health records software.

Ability to drive and willingness to work at any Carastar location as needed.

QUALIFICATIONS

Associate's degree in business, accounting, medical billing, or related field; or

High school diploma plus 5 years of experience as a Medical Biller, with direct medical billing experience with Medicaid, Medicare, and commercial insurance.

Must hold a valid driver's license and maintain a driving record acceptable to Carastar's insurance carrier.


Must maintain at least liability insurance on personal vehicles.