Billing Specialist

POSITION PURPOSE

Maintains client accounts, submits claims to insurance companies and Medicaid, and generates client invoices.

ESSENTIAL FUNCTIONS & BASIC DUTIES

1. Verifies individual client’s private insurance and Medicaid for Admissions in order to provide parents/guardians with payment estimates prior to scheduling appointments.
2. Completes prior authorization requests for private insurance clients and maintains them, as required.
3. Uses private insurance and Medicaid verifications to set up all payor sources in applicable billing system to ensure that billing is submitted to the correct primary, secondary, and tertiary payor sources. Updates and maintains client information upon notification of changes. If there are changes to individual accounts which affect ACCESS’s ability to bill for services, Accounts Receivable Supervisor should be notified immediately.
4. Submits Medicaid bulk eligibility requests in deTaso at the beginning of each week. Places billing on hold for clients that are determined to be ineligible. Contacts parents regarding status of Medicaid and monitors status. Keeps Accounts Receivable Supervisor apprised of status.
5. Processes medical records requests from insurance companies.
6. Works partial payments and denials in both systems. Coordinates with Clinical Services Coordinator (CSC) to determine status of therapy prior authorizations. Researches classroom, therapy, and AERC denials and partial payments. Works with Waiver Department to obtain needed prior authorizations or to work through problems. Recommends and submits write offs to Accounts Receivable Supervisor for review and approval.
7. Prints, reviews, and mails monthly statements. Discusses any accounts with larger than typical or questionable balances with Accounts Receivable Supervisor prior to mailing.
8. Files and maintains paperwork related to billing records, including insurance Explanations of Benefits (EOB), Remittance Advices (RA), etc. 
9. Completes relevant and approved in-service trainings.
10. May perform other related and non-related duties, as assigned.  

COMPETENCIES

Ethics:

• Treats people with respect. 
• Inspires the trust of others. 
• Completes work ethically and with integrity. 
• Upholds organizational values. 

Dependability:

• Follows instructions and responds appropriately to supervisory direction and feedback.
• Takes responsibility for own actions.
• Follows through on commitments.
• Completes tasks within established timeframes or notifies appropriate person with an alternate plan.

Interpersonal Skills:

• Focuses on solving conflict instead of blaming.
• Maintains confidentiality. 
• Listens to others without interrupting. 
• Keeps emotions under control. 
• Remains open to others’ ideas and displays willingness to try new things.

Professionalism:

• Communicates with others in a tactful and professional manner.
• Responds well under pressure.
• Treats others with respect and consideration, regardless of their status or position. 

Problem Solving:

• Identifies and resolves problems in a timely manner.
• Gathers and analyzes information skillfully.
• Develops alternative solutions.
• Works well in group problem-solving situations.
• Uses reason, even when dealing with emotional topics. 

Planning/Organization:

• Prioritizes and plans work activities.
• Uses time effectively and efficiently.
• Plans for additional resources.
• Sets goals and objectives.
• Develops realistic action plans. 

Quality:

• Demonstrates accuracy and thoroughness.
• Looks for ways to improve and promote quality.
• Applies feedback to improve performance.
• Monitor own work to ensure quality. 

Teamwork:

• Balances team and individual responsibilities. 
• Exhibits objectivity and openness to others’ views.
• Gives and welcomes feedback.
• Contributes to building a positive team spirit.
• Puts success of team above own interests. 
• Supports everyone’s efforts to succeed. 

PHYSICAL DEMANDS

While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.

The noise level in the work environment is usually moderate.

QUALIFICATIONS

Education/ Certification:

• Minimum of high school diploma or equivalent. 

Experience/ Knowledge required:

• Minimum of one year of successful experience in a similar position. 
• Knowledge of and experience in medical billing preferred.

Skills/ Abilities:

• Ability to communicate effectively and professionally with a wide variety of people.
• Strong organizational skills with attention to detail and accuracy. 
• Basic computer skills which includes a working knowledge of databases, word processing, spreadsheets, and Internet software. 
• Ability to handle multiple tasks in a very busy environment. 
• Ability to defuse escalated situations while maintaining excellent customer service.
• Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations. 
• Ability to add, subtract, multiply, divide, in all units of measure using whole numbers, common fractions, and decimals. 
• Ability to apply common sense understanding to carry out detailed, but uninvolved, written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations. 

TRAVEL REQUIREMENTS

• Travel is not required for this position.
• ACCESS drivers are required to maintain a valid Driver’s License, current auto liability insurance and registration, a clean driving record, and physical ability to drive to local locations throughout Arkansas.