Billing Specialist

Job Description

Job Description

Community Action Partnerships of Western Nebraska (CAPWN) is a non-profit community-based health and human services organization that serves low-income, disadvantaged and those unable to meet their needs through other sources. The agency was established in 1965 and provides services to over 9,000 individuals, children and families in three main areas:

• Community Health Services : WIC, Commodity Supplemental Food, Foster Grandparents, Head Start, and Child Development Center.
• Clinical Health Services : Primary Care, Reproductive Health, Diabetes Management, Immunizations, Migrant Health, Ryan White HIV; Behavioral Health including Counseling Services, Medication Management, Medication Assisted Treatment and Substance Use Counseling and Intensive Outpatient Services and Dental Services. 
• Supportive Health Services : Family Stabilization, a Teen Outreach Program, SOAR, Youth Leadership Program, Youth Shelter and Housing Assistance Programs. 

OUR PROMISE : Community Action changes people’s lives, embodies the spirit of hope, improves communities, and makes America a better place to live. We care about the entire community, and we are dedicated to helping people help themselves and each other. 

VISION

Communities where everyone has an opportunity for a successful life.

MISSION

The Mission Statement of the Community Action Partnership of Western Nebraska is to provide quality services and promote learning opportunities to improve nurture the health and well-being of Western Nebraska communities.

KEY BELIEFS

• Integrity— We treat all people with dignity and respect.
• Compassion— We believe working compassionately with people enriches all.

• Inclusion— We are inclusive and advocate for diversity.
• Collaboration— We believe working in partnerships strengthens communities; we seek mutually beneficial partnerships that advance a common mission.
• Innovation— We embrace opportunities to learn, grow and make wise choices.

COMPETITIVE BENEFITS PACKAGE :

● Health ● Dental ● Vision ● Health Savings Account (HSA) ● Flex Plan ● 401k ● Basic and Voluntary Life Insurance ● Eleven Paid Holidays ● PTO ● Extended Illness (EIB) ● Employee Assistance Program ● Aflac ● Community Discounts ● Potential for Incentive Pay ●

Fulltime (40 hours)

7:00 AM - 4:00 PM

Monday through Friday 

****REQUIRED: ONSITE Position*****

Job Title: Billing Specialist

Reports To: Billing Manager

Areas of Responsibility: Responsible for all aspects of the Health Center’s billing including charge entry, general coding guidelines, payment posting, account receivables management, rejection, and denial management.  

Major Duties :

1. Work with patients to answer billing questions and concerns; facilitate error correction when needed or escalate to the appropriate internal party. 
2. Maintain and update spreadsheets and tracking pertaining to account balances, aging, and claim rejections/denials accurately and timely.  
3. Complete daily account billing: generate claims, mail claims or send electronically to appropriate insurance carrier. Routinely analyze and work claims that are rejected or denied.
4. Assure adjustments and payments are made appropriately and accurately in the Electronic Practice Management system.
5. Remain current with agency billing policies and ensure billing processes are following agency billing policies.
6. Assure timely identification of patient account credit balances and processing of refunds.
7. Manage accounts receivable by performing collection activity procedure to past due A/R accounts of insurance carriers and clients.
8. Make recommendations to the Billing Manager for problem resolution and identification of erroneous processes at the front end of the billing cycle and encounters.
9. Accurately document all activity taken in each patient’s account.
10. Maintain understanding of 3rd party billing hierarchy.
11. Maintain understanding of current coding and billing regulations and compliance requirements for the Bureau of Primary Health Care, Medicaid, Medicare, and private billing/insurance companies.
12. Remain current with ICD-10, CPT and HCPSS codes and users.
13. Participate in educational activities and attend regular team and agency meetings. 
14. Maintain confidentiality of records and communications following HIPAA privacy and security policies and procedures.  
15. As a CAPWN team member, dedicate your energy to providing high quality, value-added customer service and care to our clients. Embrace the CAPWN Standard of Behavior, practicing integrity, strong communication and respect for leaders and peers. Engage with the team and commit to improving and nurturing the health and well-being of the Western Nebraska Communities we serve.  
16. All other duties as assigned.

Working Conditions :

• General office environment: work is generally sedentary in nature but may require standing and walking for up to 10% of the time.
• May encounter stressful environment where timelines are critical.

Physical Requirements:

• Must be able to read, write, and communicate fluently in English. 
• Must be physically and emotionally able to work with clients, vendors, and other employees.
• Must regularly talk, hear, and have close vision ability. 
• Ability to bend, stoop, squat, crouch, push and pull file drawers.
• Fine manipulation of the hands with repetitive action including typing.
• Operate office machines, printers, computers, adding machines.
• Occasional lifting and carrying up to 20 pounds.

Minimum Qualifications:

Grade: 2

1. High School diploma or GED required. 
2. Two years’ experience with health-related billing processes preferred.
3. Ability to develop and utilize an understanding of medical terminology.
4. Have computer skills to navigate and input data into established medical software.
5. Have general knowledge and understanding of data collection processes. 
6. Possess strong organizational skills, attention to detail and ability to work with high accuracy.

Grade: 3

1. Meet the minimum qualifications above.
2. Have four years’ experience with health-related billing processes.
3. Have knowledge of and experience with billing first and third-party claims and management of accounts receivable and reporting criteria.

Grade: 4

1. Meet the minimum qualifications above.

1. Six years’ experience with health-related billing processes OR

1. Hold an associate degree in Health Information Management or related degree.

" We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, protected veteran status, or any other characteristic protected by law ."