Billing Specialist II

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Responsibilities Ensure all claims are submitted for prompt payment (20%) Review, batch, and transmit/print claims/statements in a timely fashion. Handle rejected files/claims at time of submission to ensure all claims are received at the Clearinghouse and sent to insurers/patients. Maintain Accounts Receivable (AR) (20%) Monitor AR to maintain a days‑in‑AR ratio of less than 90 while keeping a standard gross‑collection ratio. Collaborate proactively with insurance companies and patients to resolve issues that will lead to payment. Communicate to the Manager any backlogged AR. Ensure credit balances are worked within 60 days. Process payments and rejections (20%) Process and post Credit Card, EOB, and ERA payment files accurately and timely to balance deposits and postings for each batch. Coordinate with other billing staff to ensure all payments/deductibles/copays are posted monthly. Input CAS codes (including rejection codes), date, and COB information at posting and approve secondary claims so they are transmitted to secondary insurers the following day. Resolve rejected claim issues to ensure payment (20%) Work on all rejected claims in a timely fashion. Research rejections—including calling insurers to understand needed corrections—and follow through on re‑submission based on insurance requirements. Communicate claim issues with Manager and staff. Assist department in maintaining patient accounts and providing customer service (20%) Answer telephone calls from patients and insurance carriers, providing complete and accurate information to resolve claim‑related issues and collect payment. Initiate payment plans and review patient accounts to obtain payment and clean up all visits on the account. Verify all outstanding visits or credit balances are handled correctly. Advise patients of past‑due balances, arrange payment or budget plans, and coordinate Collection Agency balances as needed. Handle incoming mail per Manager instruction. Assist other specified positions as assigned, preparing applications and paperwork to complete processing in a timely manner. Marginal Job Duties Acts as backup to other Specialists as directed by Manager. Level I: Performs duties as assigned. Level II: Senior Level Billing Specialist must review AR, identify trends in rejected claims, research causes and solutions, train staff, and assist management with department policies. Level III: Senior Level Specialists with certifications (CPC, RHIT, RCC) or a degree provide advanced support, coordinate with staff, and work independently to complete tasks accurately and on time. Job Specifications Education & Experience Billing Specialist I (Entry Level) High School Diploma. Coursework in Medical or Dental Billing OR minimum one year of experience in Medical/Dental Billing with processing of EOB and ERA files. Billing Specialist II (Senior Level) High School Diploma. Associate’s degree in Medical or Dental Billing OR minimum two years’ experience and three years’ desired experience in medical/dental billing, including EOB/ERA processing, CPT/ICD‑10/LCD/NCD use, handling rejected claims, appeals, and timely filing limits. Medicaid and Medicare billing experience required. Billing Specialist III (Senior/Certified Level) Associate degree and/or Billing certificates (CPC, RHIT, RCC). Minimum three years’ required and five years’ desired experience in medical/dental billing with the same skill set as Level II plus advanced knowledge. Licensure: Level II (Senior Certified) – Certifications (CPC, RHIT, RCC) Knowledge Level I: Understands EOB/ERA processing, payments, and rejections. Level II & III: Proficient in CPT, ICD‑10, LCD, NCD, modifiers, payor guidelines, minimal resubmissions, corrected claim submissions, appeals, and timely filing limits. Medicaid and Medicare billing essential. Skills Strong data entry; high-volume accuracy. Mathematical and reconciliation skills. Proficient with Outlook, Word, Excel, and 10‑key. Excellent organization, attention to detail, and multitasking. Bi‑lingual (English/Spanish) preferred. Adherence to HIPAA guidelines. Ability to work independently and under pressure; quick learner; collaborative with staff and management. Abilities Trainable with specific instruction. Effective communication with staff, patients, and management. Ability to work with limited supervision; maintains current job knowledge. Senior level staff can work independently and assume additional responsibilities. Respectful toward all individuals. Physical Effort Must be able to sit, stand, walk, lift, carry, push, pull, or twist up to 25 lbs occasionally. Hours of Work: Full‑time, flexible and varied. Travel: Extensive local travel between sites; occasional seminar travel; mileage and travel reimbursement per GLBHC travel policy. Education: None (outside of specified levels). Experience: Experience in family or dental practice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Great Lakes Bay Health Centers