Billing Specialist

Under the supervision of the Accounting Manager, process billing and collections for all Private Pay, Medicaid and other 3rd party payers.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Coordinates with Pine Castle’s various programs to process billing for Social Security, Medicaid, APD, CDC and private pay participants/residents on a monthly basis.
• Creates and sends monthly invoices to Private Pay participants and residents.
• Ensures all service authorizations have been received and are correct prior to billing.
• Coordinates with the Accounting Manager to facilitate collections of all outstanding private receivables and provides an itemization of all bad debt, voids, and adjustments, on a monthly basis.
• Provides documentation to participants and/or their personal supports, program staff and auditors as needed, ensuring correct state and federal billing protocols have been performed.
• Communicates with programs, operations and accounting staff to identify and resolve billing and issues.
• Creates and update spreadsheets for customer billings and reconciliations.
• Maintains required billing records, authorization forms, reports and files.
• Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
• Participates in educational activities and attends departmental meetings.
• Assists with special projects or other assignments as needed.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE:

• Bachelor’s degree in accounting from a four-year college or university and one year of professional experience; if lacking a four-year degree, five years of professional experience in billing, accounting or receivables may be substituted for the degree.
• Minimum one (1) year experience with Accounts Receivable/Billing, preferably in a Healthcare setting.
• Experience with Windows, accounting software and data entry.

KNOWLEDGE of:

• Accounts receivable and billing procedures.
• Private billing requirements.
• Knowledge of billing clean claims; Medicare/Medicaid and commercial insurance carriers.
• Obtaining authorizations and working appeals.
• Expertise to correct and resubmit claims denied for billing errors.
• Utilization of insurance web portals.
• EOB interpretation.
• Handle clearinghouse reconciliation and rejections.
• Some expertise working with ACH payments.

CERTIFICATES, LICENSES, REGISTRATIONS:

Maintains required training certifications (CPR, First Aid, HIPAA, Direct Care Core Competencies, Zero Tolerance, etc.)

OTHER SKILLS and ABILITIES:

• Excel (experience with pivot tables and v-lookup preferred).
• Excellent written and oral communication skills.
• Attention to detail, time management and prioritization skills.
• Ability to work independently and with minimum supervision.
• Ability to collect data and to understand information related to data obtained.
• Ability to recognize and define problems, establish facts, and draw valid conclusions.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to walk; use hands to finger, handle, or feel objects, tools, or controls; and reach with hands and arms.

This employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.