Billing Representative - Lee Agency/Brighton Consulting Group

Job Description

Job Description

Job Description

Billing Representative

Claims/Accounts Receivable department

Position Summary:

The Billing Representative is a cross-functional development role designed to build proficiency in both claims billing and accounts receivable. This position will complete structured training, support day-to-day work across both teams, and develop the knowledge and skills needed to transition into a full-time Claims Representative or Accounts Receivable Representative position as business needs and openings arise.

General Job Duties:

• All employees are responsible for a basic knowledge of the employee handbook and must conduct themselves with behavior that supports these values.
• All employees are responsible for making the most of their working time and reach maximum potential by being on time for appointments, checking voicemails/emails as appropriate, and completing deadlines in a timely manner.
• All employees are expected to escalate issues as necessary.
• All employees will specifically be trained on their job duties, however; other mandatory trainings may be deemed appropriate by management for one or all members of the team.
• All employees must occasionally collaborate with the leadership team to create, revise, and maintain accurate job descriptions.
• All employees must occasionally train new team members and cross train as appropriate.
• All employees must keep client information confidential and in accordance with regulations.

Essential Job Functions:

• Participate in structured cross-training in both Claims and Accounts Receivable, including applicable systems, workflows, payer requirements, client procedures, and processing deadlines.
• Learn and perform assigned Claims functions under appropriate guidance, including claim preparation and submission, payment follow-up, account review, discrepancy research, and documentation of collection activity.
• Learn and perform assigned Accounts Receivable functions under appropriate guidance, including deposit entry, census balancing, ancillary charge entry, resident statements, account corrections, bank reconciliation, and month-end processing.
• Support Claims and Accounts Receivable team members based on workload, coverage needs, training progress, and departmental priorities.
• Complete assigned work accurately and within established facility, payer, and internal deadlines.
• Research account, payment, eligibility, and billing discrepancies; document findings clearly and escalate unresolved or high-risk issues in a timely manner.
• Maintain accurate notes, records, and supporting documentation so account activity and follow-up are clear to clients and other team members.
• Develop working knowledge of Medicare, Medicaid, Managed Care Organizations (MCOs), commercial insurance, hospice, waiver, and private-pay billing processes applicable to assigned clients.
• Communicate professionally and proactively with clients, payers, and team members; provide timely updates and ensure questions or concerns are directed to the appropriate person.
• Demonstrate steady progress toward independently managing assigned client responsibilities in either Claims or Accounts Receivable.
• Remain flexible and prepared to transition into a full-time Claims Representative or Accounts Receivable Representative position when an appropriate opening becomes available.
• Complete client education, relationship-building activities, special projects, and other duties as assigned.

Position Requirements: 

The requirements listed below are representative of the knowledge skills and abilities required. Employees who do not possess the requirements for a job at the time of hire will not be considered for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Skills and Experience:

• Capable of working effectively independently and in a team environment
• Must be self-motivated, goal and detail oriented
• Flexible and adaptable to changing work environment
• Ability to prioritize multiple tasks and manage time efficiently
• Communicate in a positive manner with clients and escalate any issues and/or messages to the leadership team
• Basic proficiency in computer skills and financial duties pertaining to business operations
• Flexibility pertaining to client needs and requests
• Must be able to efficiently use Microsoft operating systems, with high proficiency in Excel

Desired Skills and Experience:

• Wellsky Software
• Experience with HIPPA compliance and PHI
• Working with insurance or healthcare administration/billing
• Medical or clinical background, preference given to long-term care experience
• An Associate Degree in Accounting or similar field or relevant work experience

Language Requirements:

The primary language of Brighton Consulting Group is English. Excellent communication skills are defined as the ability to:

• Actively listen for total comprehension
• Ask questions that enhance the understanding of a certain topic
• Relay information and/or instruction in a descriptive and understandable fashion in both written and verbal forms

Physical Requirements:

Occasional lifting up to 20 lbs. may be necessary from time to time. Must be able to sit for long periods of time, use fine motor skills, have the ability to view a computer monitor, and type (up to 8 hours a day). Additionally, there may be exposure to moderate noise levels due to the office functions (i.e. talking, printing, copying, etc.)

FLSA Status:

Non-exempt/Hourly: This position is paid an hourly rate and therefore is eligible for 1.5 times the normal wage for every hour over 40 worked in a given work week. Overtime must be preapproved by your supervisor.

Employment Status:

Full time: This position at BCG requires at least 40 hours a week. Occasionally, time over 40 hours may be necessary to meet the requirements of the position. Full-time employees are eligible for employee benefits.

Supervision Requirements:

This position supervises: None.

This position reports to: Accounts Receivable/RAM Supervisor but could change to report to Claims Supervisor or the Claims Compliance Manager or RAM Manager depending on specific business need.