What are the responsibilities and job description for the Billing Specialist position at The Whole Child - Mental Health & Housing Services?
JOB OVERVIEW:
The Mental Health Billing Specialist is responsible for submitting and tracking insurance claims, handling credentialing and contracting with insurance companies, and keeping client billing accounts accurate and up to date. Additional administrative duties may be assigned on an as-needed basis.
ESSENTIAL FUCTIONS:
- Review and verify patient insurance benefit information to clients as they are registered for services
- Submit the client’s information on IBHIS
- Prepare and submit electronic or paper claims to insurance companies
- Follow up on unpaid or denied/rejected claim
- Resolve billing discrepancies and appeals
- Ensure all clients have their Payer Financial Information (PFI) up to date.
- Provide regular reports of billing data and activity
- Communicate with clients as needed regarding insurance and billing
- Occasional administrative duties as needed to support the admin team (communicating with clients, responding to new client inquiries, etc.)
- Credentialing newly licensed providers and for students/associates with appropriate insurance companies
- Attend staff meetings, admin team meetings, and other scheduled meetings as needed
- Maintain accurate and up-to-date patient financial records
- Utilize medical coding systems such as ICD-10
- Collaborate with office staff to ensure proper documentation for billing purposes
- Stay updated on changes in medical billing regulations and coding guidelines
- Maintain HIPAA compliance with claims management and communication
- Other duties as assigned.
QUALIFICATIONS:
Required
- High school diploma or equivalent
- Experience with Medi-Cal and DMH billing
- Strong knowledge of medical terminology, coding systems, and billing procedures such as CPT codes and modifiers
- Proven experience as a Medical Biller to include commercial insurance (min. 2 years required)
- Excellent attention to detail and accuracy in data entry
- Strong organizational, communication, and time management skills
- Ability to work independently and prioritize tasks effectively
Preferred
- Proven experience as a Medical Biller to include commercial insurance, including but not limited to BCBS, Aetna, Anthem, Cigna, Kaiser, Providence
- Certification in medical billing preferred
- Experience in Mental Health field
- Proficient in using different medical billing software’s (EXYM) and electronic health record (EHR) systems
CONDITIONS OF EMPLOYMENT:
Employee may be asked to participate in cross-training programs or pursue additional education or training when it is determined to be in the best interest of the company by the Chief Operating Officer and Chief Executive Officer.
This class specification is only intended to identify the classification and to illustrate the duties, responsibilities, and requirements for it. It is not intended, nor should it be interpreted to describe each and every duty employee assigned may be required to perform.
WORKING CONDITIONS: Work is performed in normal office setting. Noise level is moderate with occasional loud outbursts.
REASONING ABILITY: Ability to solve practical problems and deal with a variety of variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
PHYSICAL DEMANDS:
- Must be able to remain in a stationary position 50% of the time.
- Needs to occasionally move about inside the office to access file cabinets, office machinery, etc.
- Constantly operates a computer and other office productivity machinery, (i.e., calculator, copy machine, computer and printer).
- Constantly communicates with staff.
- Occasionally operates motor vehicle for business purposes.
The Whole Child is an equal employment opportunity employer and no candidate for employment will be rejected on account of race, color, religion, national origin, age, marital status, or sex. Candidates with physical impairments will be considered so long as it can be reasonably demonstrated that the duties and responsibilities can be effectively performed without hazard to the individual, fellow employees, or clientele.
