MULTI LEVEL JOB SUMMARY

The Billing Specialist I (Entry Level) is responsible for the following tasks including but not limited to submission of timely claims, processing and posting payments, working rejected claims and assisting with billing and payment issues. Researching and working rejections correctly per billing department requirements for immediate resubmission to ensure maximization of revenue collected.

The Billing Specialist II (Senior Level) is expected to accurately process and post payments and rejections and find immediate resolution to billing issues in the department. Acting as a Mentor to the Billing Specialist I and being a team player. The Senior Level will monitor trends and communicate with department on any issues or updates that need to be addressed immediately while ensuring all AR is kept current working with no supervision knowing when and how to handle various situations and the importance of completing them. 

The Billing Specialist III (Senior/Certified Level) staff that are certified or have a higher level of education and have additional Assistant/Lead duties assigned are responsible for communicating and performing any duties in that department when needed. This advanced level will work independently and ensure tasks are completed accurately and timely and keep current on changes.

ESSENTIAL JOB DUTIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ensure all claims are submitted for prompt payment. (20%)
   • Review, batch, and transmit/print claims/statements as assigned in a timely fashion.
   • Work any rejected files/claims/statements at time of submission to ensure all claims sent were received at Clearinghouse and sent to insurances/patients.

1. Maintain AR. (20%)

• Monitor the assigned AR to ensure maintenance of a days in AR ratio of less than 90 while maintaining a standard gross collection ratio.
• Work collaboratively and proactively with insurance companies and patients to resolve issues that will lead to payment.
• Communicate to Manager any backlogged AR.
• Ensure credit balances are worked within 60 days.

1. Process Payments and Rejections. (20%)

• Process and post Credit Card, EOB and ERA payment files timely and accurately to ensure we balance deposits to postings for every batch.
• Coordinates with other billing staff to ensure all payments/deductibles/copays are posted monthly.
• Input CAS codes (including Rejection codes), date and COB information at time of posting and approve secondary claim to ensure claims are transmitted to Secondary Insurances the day after posting.

1. Responsible for resolving rejected claim issues to ensure payment of claim. (20%)

• Ensure all rejected claims are worked in timely fashion.
• Research rejections which include calling insurances to help understand what needs to be corrected and follow through on resubmission of claim based of insurance requirements.
• Communicate with Manager and staff on claim issues.

1. Assists department maintaining patient accounts and providing customer service. (20%)

• Answer telephone calls from patients and insurance carriers, providing complete and accurate information to resolve any claim related issue in effort to collect payment on services rendered.
• Initiate payment plans and review patient account in efforts to obtain payment and clean up all visits on the patient account.
• Verify all visits that are outstanding or have credit balance are worked correctly and resolved.
• Advise patients of balances that are past due, attempt to obtain payment/set up budget plans and coordinate Collection Agency balances as applicable.
• Handle any incoming mail as instructed by Manager.
• Act as assistant to other specified positions as assigned. Prepare applications and any other required paperwork in efforts to complete processing of requested documents in a timely manner.

Note: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for the job. Duties, responsibilities, and activities may change at any time with or without notice.

MULTI LEVEL MARGINAL JOB DUTIES

1. Acts as backup to other Specialists as directed by Manager.
   • Level I: Performs duties as assigned.
   • Level II: Senior Level Billing Specialist will need to have the advanced skill set and knowledge to review AR and find trends in rejected claims and research why it was rejected and how it can be fixed. Ability to work well with others and train staff while taking the initiative to resolve issues and know who to call and how to follow through. Knowledge of all aspects of the department is required and expectation that they can and will assist Management in following the Billing Department policies. The move to the Senior level will be given to those that are at a higher level of knowledge in the department and are able to work independently to obtain results required by Director.
   • Level III: Senior Level Specialists with Certifications (CPC, RHIT, RCC or a degree) and/or Assistant Duties are responsible for providing support/assistance to that specified Department. This requires specific knowledge and additional work at this level and the ability to coordinate with staff and work with no supervision understanding the details needed to complete the task accurately and in a timely manner.

REQUIRED JOB SPECIFICATIONS

1. Education & Experience
   • Billing Specialist I (Entry Level)
   • High School Diploma.
   • Coursework in Medical or Dental Billing OR Minimum of One (1) year of experience in Medical/Dental Billing including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files OR a combination of coursework and experience.
   • Billing Specialist II (Senior Level)
   • High School Diploma.
   • Associates degree in Medical or Dental Billing OR Minimum of two (2) years’ required and 3 years’ desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience. OR a combination of coursework and experience.
   • Billing Specialist III (Senior/Certified Level)
   • Associate degree and/or Billing Certificates (CPC, RHIT, RCC)
   • Minimum of three (3) years required and 5 years’ desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience.

1. Licensure: Level II (Senior Certified) – Certifications (CPC, RHIT, RCC
2. Knowledge: Level I: Knowledge of processing and following through on Explanation of Benefits (EOB) and ERA files including payments and Rejections.

Level II &III: Knowledge of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines. In depth knowledge of rejected claims and payor guidelines which includes minimal resubmissions, corrected claim submissions, appeals and understanding timely filing limits. Medicaid and Medicare billing experience is required.

1. Skills: Strong data entry skills; ability to input a high-volume information accurately. Adept math skills with strong ability to perform reconciliation functions. Organized and detail oriented. Must have good computer skills, proficiency with Outlook, Word, and Excel. Proficient 10 key skills. Bilingual (English/Spanish) preferred. Demonstrates strict adherence to HIPAA guidelines. Expertise in working rejections to resolve issues and obtain timely payment of claims independently. Ability to multi-task and provide a high level of productivity while maintaining accuracy. Must be able to work under pressure. Understand collection process. Desire to learn and master new things, seek help when needed and willingly assist others in time of need. The Senior level will have to show that they have mastered the skills above and are able to move to the next level meeting criteria of next level as described above.
2. Abilities: Trainable and able to follow specific instructions. Ability to communicate effectively with other staff, patients, and management. Able to work with limited supervision and keep current with all job duties. Senior Level staff must show that they have the ability to move to the next level assisting Director in duties as needed and can work with no supervision and are willing and able to take on more responsibilities in the department. Ability to treat everyone with respect.
3. Physical Effort: Must be able to sit, stand, and or walk for an entire workday. Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs. occasionally.
4. Hours of Work: Full-time. Flexible and varied.
5. Travel: Extensive local travel between sites. Occasional seminar travel. Mileage and travel reimbursement according to GLBHC travel policy.

PREFERRED JOB SPECIFICATIONS

1. Education: None
2. Experience: Experience in Family or Dental Practice.