Billing Specialist

GENERAL DESCRIPTION:

This  position will report to the Manager of Business Services.  This role will be responsible for all aspects of client-driven accounts receivable, enrollment, eligibility, and certain aspects of related data reporting/Electronic Health Record functions.  Responsibilities include a mix of day-to-day routine tasks as well as more complex non-recurring/project-based tasks.

POSITIONS SUPERVISED:

1. None

ESSENTIAL DUTIES AND RESPONSIBILITIES: 

1. Daily Responsibilities:
2. Upload all claim remittance files into Netcare’s Electronic Health Record and reconcile payments to banking records
3. Resubmit, appeal, write off, or take other necessary action on denied, rejected, or partially paid claims
4. Verify insurance, Medicaid, or other payor eligibility for all billable programs
5. Enroll eligible clients into the ADAMH Board of Franklin County’s claims system

1. Weekly/Monthly Responsibilities:

1. Reconcile accounts receivable in the General Ledger to the Electronic Health Record and take action on any remaining unpaid aged claims
2. Manage “Bed Management” module in Electronic Health Record to post and bill residential day-rate (per diem) claims

1. Other Responsibilities:

1. Document and/or update standard operating procedures surrounding billing processes[BM1] [ES2] 
2. At the direction of the Manager of Business Services, this role may also be responsible in a shared capacity for:
3. i.        Reviewing billable services to determine whether corrections in the Electronic Health Record are needed prior to preparing/billing claims files (or paper claims, when applicable)
4. Preparing and billing 837 files (or paper claims, when applicable) to insurance, Medicaid, ADAMH, and other payers.[NK3] [ES4] [VD5] [BM6] [ES7] [NK8] 
5. Adjusting Electronic Health Record adjustments sent by clinical staff
6. Investigating and resolving technical claims/charge/payment-related issues in the Electronic Health Record
7. Assisting HR with credentialing staff in certain payor systems such as Medicaid, Medicare, and insurance portals
8. Gathering and organizing data for periodic claims audits or medical records requests
9. Other billing-related reports or tasks, as assigned

ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES:

1. Experience with an Electronic Health Record and Clearinghouse
2. Experience with CPT & HCPCS codes
3. Experience with Ohio Medicaid & Managed Care
4. Strong Microsoft Excel skills
5. Strong attention to detail, organizational skills, and deadline/close-cycle management skills
6. Ability to  communicate effectively with frontline and management staff as well as external vendors.

MINIMUM QUALIFICATIONS:

At least two years in medical billing, preferably in behavioral healthcare specifically.

Knowledge of insurance verification, claims submission, follow-up, and appeals processes

Associates Degree minimum preferred, but not required

 [BM1]Does this make it sound more managerial than a line staff would typically be?

 [ES2]If we don't want them to do this, then Vickie and I will have to do this, which would be fine in theory - just something we need to talk about

 [NK3]Same here!

 [ES4]Updated - thanks!

 [VD5]Are you suggesting the removal of preparing and submitting the claims?

 [BM6]Yeah, something here doesn't read correctly when put into simple view/changes accepted mode.

 [ES7]Removed changes

 [NK8]I was mostly just referring to the specific numbers - sorry, that should have been more obvious highlighting on my part!