Billing Specialist

POSITION SUMMARY:

The Billing Specialist will perform a variety of complex accounting functions for the Agency that include working on ERA reports as they relate to payer denials and incorrect processing of medical claims. The Billing Specialist will also work EHR AR activities regarding payer payments, missing payments, and will include working Clearinghouse Claims that involve payer rejections and incorrect processing of medical claims and providing ongoing follow-up throughout the resolution process. Additionally, the Billing Specialist will respond to client calls, when necessary, work closely with team leaders and department management, and act as a resource to agency staff.

ESSENTIAL FUNCTIONS:

1. Manage the overall aging of claims within CareLogic database for all Insurance including Private, Government, Board Program plans


2. Correct Clearing House Rejections


3. Perform AR review for under/over payments, missing payments, zero payments, etc. and work to resolve outstanding AR within the CareLogic and ADAMH Smartcare


4. Reconcile open-balance reports to ensure accuracy of payment by posting variance activities performed within the CareLogic and ADAMH Smartcare database and process account adjustment, as necessary


5. Assist in Denial Report discrepancies identified in CareLogic and Smartcare and work to reconcile outstanding balance, as needed


6. Assist with 270/271 Eligibility Report to correct client information and any discrepancies


7. Assist with payer correspondences, disputes, appeals and other collection projects as required


8. Resolve financial report discrepancies


9. Participates routinely in department and company meetings, as necessary


10. Communicate with Agency and Insurance Companies on insurance eligibility, billing issues and work to resolve client questions


11. Verify and submit Prior Authorizations for client to private and public insurance


12. Coordinates with other departments consistently seek improvement of all billing functions to ensure department activities are conducted efficiently and ethically


13. Demonstrates working knowledge of Behavioral and Mental Health billing/coding for Medicare, Medicaid, National and Local Commercial insurance provider types


14. Ensuring management is notified of changes to guidelines published for review through provider portals, newsletters and correspondence notifications supplied by all third-party payors


15. Maintains strict confidentiality and adheres to all guidelines and regulations regarding patients’ medical records and billing records, Operations Policies and Procedures and HIPAA


16. Participates in relevant continuing education, in-service training to improve professional competency and ensure that all daily activities are completed efficiently, and of company goals are achieved


17. Enters Brief Addiction Monitoring (BAMS) and Outcome Questionnaires (OQ) forms in system


18. Assist with billing inquiries, records requests, and taking incoming calls


19. Providing front desk coverage support as needed

SKILLS AND ABILITIES:

• Knowledge/proficiency in all Microsoft Office applications


• any Electronic Health Records database


• Ability to actively listen and understand others


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Education:

Associate’s degree in coding and billing, or equivalent to two years’ experience in Behavioral Health Billing and Medical Insurance. A combination of training, education and experience that is equivalent to the requirements listed above is Acceptable in providing the recommended knowledge, skills, and abilities required.

Additional Qualifications:

• Familiar with CPT codes


• Experience with Medicaid/Medicare/Commercial insurance and billing

Other Requirements

Must possess a valid Ohio driver's license; must pass a criminal background check and a pre-employment drug screen