Billing Specialist

POSITION PURPOSE

Maintains client accounts, submits claims to insurance companies and Medicaid, and generates client invoices.

ESSENTIAL FUNCTIONS & BASIC DUTIES

• Verifies individual client's private insurance and Medicaid for Admissions in order to provide parents / guardians with payment estimates prior to scheduling appointments.
• Completes prior authorization requests for private insurance clients and maintains them, as required.
• Uses private insurance and Medicaid verifications to set up all payor sources in applicable billing system to ensure that billing is submitted to the correct primary, secondary, and tertiary payor sources. Updates and maintains client information upon notification of changes. If there are changes to individual accounts which affect ACCESS's ability to bill for services, Accounts Receivable Supervisor should be notified immediately.
• Submits Medicaid bulk eligibility requests in deTaso at the beginning of each week. Places billing on hold for clients that are determined to be ineligible. Contacts parents regarding status of Medicaid and monitors status. Keeps Accounts Receivable Supervisor apprised of status.
• Processes medical records requests from insurance companies.
• Works partial payments and denials in both systems. Coordinates with Clinical Services Coordinator (CSC) to determine status of therapy prior authorizations. Researches classroom, therapy, and AERC denials and partial payments. Works with Waiver Department to obtain needed prior authorizations or to work through problems. Recommends and submits write offs to Accounts Receivable Supervisor for review and approval.
• Prints, reviews, and mails monthly statements. Discusses any accounts with larger than typical or questionable balances with Accounts Receivable Supervisor prior to mailing.
• Files and maintains paperwork related to billing records, including insurance Explanations of Benefits (EOB), Remittance Advices (RA), etc.
• Completes relevant and approved in-service trainings.
• May perform other related and non-related duties, as assigned.

COMPETENCIES

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Problem Solving :

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PHYSICAL DEMANDS

While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and stoop, kneel, crouch, or crawl. The employee must frequently lift and / or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

The noise level in the work environment is usually moderate.

Requirements

QUALIFICATIONS

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Experience / Knowledge required :

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TRAVEL REQUIREMENTS