Billing Specialist-Administative Assistant

Position Description

Billing Specialist - Admin. Assistant ADHC will be responsible for data entry into EI-Care, submitting of electronic/paper billing, account statements, and for follow-up on outstanding balances for the Adult Day Health Care program to the appropriate insurance plan for reimbursement. In addition, The Billing Specialist - Admin. Assistant is responsible for coordinating the routine administrative needs of the ADHC and directs all office activities in coordination with the Vice President of the ADHC.

Essential Job Functions

The following duties are mandatory requirements of the job:

Data Entry

• Create weekly billable spreadsheet based off of the clients Prescription for Care from EI-Care that deemed that visit billable for the day.
• Serve as an audit liaison to provide support and assistance during a financial/grant audit or review.
• Provide Front Desk coverage for the Willis Green ADHC as needed.
  
  

Administrative

• Update the Prescription for Care (PFC):
• Update the PFC for clients presented in care plan the previous day.
• Add and remove clients as needed, update Social Workers assignments, update groups assigned as per Clinical Director and/or Senior Social Worker.
• Update EI-care daily:
• Add new clients, close discharged clients, and update Social Workers case assignment.
• Update enrollment grid daily (add new clients and discharged clients to the grid).
• Reconcile weekly Metro Card total:
• Create request, have it signed by Vice President of ADHC and scan signatures to finance.
• Order for metro cards are to be submitted bi-weekly.
• Reconcile daily totals and attendance for in-person, remote, inappropriate clients and metro card totals.
• Submitting of Purchase Order Requests, after item(s) was approved by VP of ADHC.
• Take and edit Community and staff meeting minutes.
  
  

Billing

• Prepares and submits clean claims to various insurance companies either electronically or on paper (UB-04 or CMS 1500).
• Ensure processes and claims submissions are compliant with all rules and regulations of the programs, state, federal and city requirements.
• Identify and bill patient insurance in the appropriate order primary and/or secondary when necessary.
• Use of ICD-9, ICD-10, CPT, and HCPCS coding systems and use of modifiers when necessary.
• Reconcile all submissions against the payment remittances received and ADS for accurate postings and denial reasons.
• Identify and resolve all denied claims with the assistance of the billing team and communicate with the programs if an additional resolution is needed.
• Responsible for collecting, posting, and managing account payments from insurance plans and self-pay patients. Ensure payments are accurately posted to patient’s accounts.
• Work collaboratively with the Billing Team members, Eligibility and Credentialing Specialist.
• Identify and resolve patient billing complaints.
• Follow-up and document in ADS the status of delinquent accounts.
  
  

Job Requirements

• Minimum of 1-3 years in a performing billing activity.
• Knowledge of any Electronic Health Record software recommended.
• Able to safeguard sensitive confidential agency and staff information.
• Experience in at an Adult Day Health Care Program (ADHC) or Federally Qualified Health Center preferred (FQHC) or Community Health Center.
  
  

Education and Certification

• High School Diploma or GED.
• Medical Billing and Coding Certificate preferred.
  
  

Special Skills And Knowledge

In addition to the above-listed job responsibilities and educational requirements, the ideal candidate for this position possesses most of or all the following:

• Ability to interact effectively with outside agencies, Board members, prospective as well as current program members, vendors, staff members, and the general public.
• Strong interpersonal skills with written and communication skills.
• Proficiency in Microsoft applications.
• General knowledge of internet navigation and research and medical billing.
• Ability to work independently and manage time effectively.
• Customer service skills and ability to respond calmly and professionally to conflict, crisis, stress, and deadlines is required.