Billing Specialist

Billing Specialist Position in a Healthcare Setting.

Job Title: Billing Specialist

Department: Clerical

Time Commitment: Full-time

Reports To: Revenue Cycle Manager

FLSA Status: Non-Exempt

Location: Urbana, Ohio

Job Summary

Under the guidance of the Revenue Cycle Manager (RCM), the Billing Specialist is responsible for working collaboratively with CHWPs Billing Company (as appropriate), and other departments to ensure timely and accurate processing of patient billing. They will assist the RCM in managing any outside third-party organizations utilized to assist with billing and collections and assisting with review and processing of claim denials as needed. They will work with the practice management system and other software vendors to manage installation, implementation and appropriate ongoing issue resolution.

Primary Accountabilities

Achieve Results

• Manage/assist with all billing and administrative processes as assigned. Ensure all relevant billing information is accurate, current and completed in a timely and accurate manner.
• Ensure clients/patients experience a high level of customer satisfaction and care.
• Provide billing specialty support for staff and activities within the Billing Department, maintaining an acceptable level of productivity and consistency will all tasks as assigned.

Operational Excellence

• Ensures that all information collected, processed, entered and filed are done so in a timely, accurate manner.
• Ensure and uphold the confidentiality requirements of all patient records and manage all daily tasks and activities consistent with HIPAA, state and federal laws and regulations, as well as the health center policies and regulations regarding confidentiality and security.

Relationship Management

• Develop and ensure effective, positive relationships with all patients, staff, vendors, contractors and related resources.
• Develop and ensure ongoing, positive relationships and collaboration with other providers, nurses, administrative and clinic operations staff.
• Ensure the success of each clinic operation through collaborative support and working relationships with all clinic operations staff.

Stewardship and Professionalism

• Ensure all actions, job performance, personal conduct and communications always represent the organization in a highly professional manner.
• Uphold and ensure compliance with and attention to all corporate policies and procedures, as well as the mission and values of the organization.

Primary Tasks & Duties

• Answer questions from patients, coworkers and insurance companies.
• Identify and resolve patient billing complaints and/or concerns.
• Evaluate patient financial status and establish budget payment plans.
• Performs various collection actions, including contacting patients by phone as needed.
• Application and verification of Clinical Procedure Coding & ICD-10 coding.
• Maintain accounts receivable for all insurance and patient accounts.
• Prepares reports and billings for hard copy and electronic transmissions
• Process monthly account statements
• Perform month-end and year-end reports
• Update fee schedules as directed by the RCM
• Problem solve computer issues related to billing processes
• Review and correct all insurance rejections
• Assist with daily reports as needed
• Update all patient and insurance information into the computer
• Keep apprised and inform providers on new insurance changes or billing codes
• Maintain competency to area of billing in which you are assigned.
• Identifies work processes and strives to improve quality improvement throughout the organization
• Assist with and maintain external provider credentialing and third-party directory maintenance
• Assist Revenue Cycle Manager (RCM) with periodic projects and assignments as needed.
• Other duties as assigned.

Essential Functions/Key Competencies

• Function in a multi-tasking, multiple priorities environment, while maintaining accuracy and attention to detail.
• Communicate with a diverse, sometimes difficult, patient/customer population. Will be required to successfully manage patients and families in often stressful or conflict situations.
• Utilize a wide variety of office technology and tools to collect, enter, process, file patient records and documentation
• Demonstrate a high level of skill at building relationships and customer service.
• Demonstrate interpersonal savvy and influence skills in managing difficult clients and patients.
• Demonstrate a high level of problem solving skill to better serve patients and staff.
• Strong attention to detail and accuracy.
• Ability to utilize computers for data entry and information retrieval.
• Excellent verbal and written communication skills.
• Ability to implement and evaluate operational and administrative processes.
• Participate in aspects related to quality compliance, improvement and risk management for a Federally Qualified Health Center
• Engage in certification projects, i.e. PCMH, JACHO, NAQH
• Engage in all corporate compliance requirements of Community Health & Wellness Partners of Logan County

Qualifications & Requirements

Education

• Preferred Associates degree in Medical Billing, Business, Finance, Healthcare Administration or IT. Experience may be considered in lieu of Degree or other Degree could be considered.
• Perform Basic Mathematical Calculations Consistently and Correctly
• Ability to relate with effectiveness to the public, patients, health care providers and reimbursement sources

Certificates and Licenses

• Valid Ohio driver's license

Professional

• Practical knowledge of entitlement programs, Medicaid and Medicare, and third-party billing.
• Expertise with ICD10 and CPT coding
• Experience in use of electronic practice management system(s) including practice management system set-up and reporting.
• Previous healthcare billing/revenue cycle operations experience including knowledge of denials management, eligibility processing and electronic payment posting, preferred but not required.
• Experience with Medicare and Ohio Medicaid
• FQHC experience preferred, but not required.
• Proficiency in knowledge of office management, use of computers, software packages (Microsoft Office), and office machines.

Physical/Environmental

• Ability to interact with computer screen (visual acuity required)
• Must have manual dexterity for use of keyboard. Ability to remain stationary, sitting, standing, for long periods of time.
• Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc.
• Capacity to function in a sometimes stressful, multi-tasking environment.

Blood Borne Pathogen Exposure (Please Check One)

• _____ Category I: Job classification includes ALL employees who have occupational exposure* to blood borne pathogens* (blood or body fluids) while performing their job duties.
• _____ Category II: Job classification includes employees who are likely to have SOME occupational exposure to blood borne pathogens because Category I tasks may occasionally be required.
• __X___ Category III: Job Classification includes those employees who perform jobs and tasks where NO CONTACT with blood borne pathogens occurs and Category I and Category II tasks ARE NOT a condition of employment.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Work Environment

The work environment characteristics are those for a normal provider office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work may require occasional weekend and/or evening hours.

Work hours

Full-time or part-time, non-exempt hourly position. Generally, a 40-hour work week is required for full-time; part-time as agreed upon by parties; hours are subject to change. Some Saturdays and after business hours work may be required. Assigned meetings and travel are a part of the position.

Wages

Starting wages for billing specialist will be negotiable based on Community Health & Wellness Partners of Logan Countys pay policies and factors such as education and experience, national and state average compensation recommendations based on location and region.

Introductory Period

Ninety (90) calendar days. The successful completion of the introductory period does not alter the at-will employment status.

Community Health and Wellness Partners of Logan County is an Equal Opportunity Employer.