Billing Specialist

PRIMARY FUNCTIONS:

Billing Specialist for integrated health outpatient clinic; responsible for generating revenues which are directly related to the success of business operations. Process billing for submission to appropriate payer for reimbursement, manages electronic information, systems, and protocol for client enrollment, demographics, dis-enrollment, encounters and claims. Works with electronic and hard-copy client records, statistics, and supports documentation integrity and data validation. Initiates routine reports, conducts, facilitates and coordinates correction of electronic data and monitors submission with internal and external stakeholders and staff; manages time-sensitive and confidential accumulative data for outpatient clinic care coordination.; acts as dedicated clinic contact for integrated health electronic data management. To include RBHA, private insurance, various Medicare plans etc.

SPECIALIZATIONS:

Ability to perform dedicated job tasks using computer-based programs, including Microsoft Office Suite, and ability to be detail-focused, managing large amounts of electronic data on a routine basis. Use discretion and independent judgement while performing work that directly and significantly affects the business operations. Professional demeanor needed to coordinate internal and external management of data with professional associates. Additionally, should possess client-centered rapport and service skills for persons seeking integrated health services who present with widely distributed requests and presenting concerns; present a professional appearance and demeanor in accordance with CPLC codes of dress, conduct, and ethics; possess punctual multi-tasking skills for a high volume environment; possess excellent verbal and written communication skills; able to work with minimal administrative supervision; competent with operating office and electronic machines.

MINIMUM QUALIFICATIONS:

High school diploma or equivalent; 2 plus years of medical billing and collections experience. Qualify as an integrated health paraprofessional or technician; combination of 6 to 12 months education and /or experience in data management and/or office administration including information processing and administrative support/customer service in a medical or integrated health setting: Experience with computer applications including MS Word, Excel, PowerPoint, Outlook, and other windows-based systems: Type 35 wpm; Bilingual English/Spanish preferred. Adequate understanding of paper specific contracts. Claimtrak experience is preferred.

JOB RESPONSIBILITIES AND COMPETENCIES:

1. Processing/billing of services provided to outpatient clinics. Submission to appropriate payer for accurate reimbursement.
2. Ongoing review of A/R as related to outstanding/denied claims and follow-up or claims research as needed.
3. Adequate knowledge/understanding of payer specific remittances EOBs for proper payment posting/contractual adjustments.
4. Adequate understanding of eligibility verification process for various payer sources.
5. Manages client electronic data on a daily basis using multiple windows-based programs, email, and telephone; adhering to documentation integrity and timeliness of submission.
6. Manages assigned tasks and client data submitted on payor-specific client information, status, and demographic forms required by CPLC and its regulatory/contractual/ monitoring authorities and agencies; including running assigned error reports, routine review and submission of assigned electronic data, and coordination and correction of errors listed on reports.
7. Monitors, in coordination with Clinical & IS staff, client enrollment, updates during treatment, discharge, claims, and system changes/enhancements errors; resolves assigned error issues; coordinates with clinical staff for corrections requiring clinical judgment; coordinates with external staff when needed.
8. Monitors timely correction of all errors as required by most current policy and procedure; notifying clinical manager/director of system/personnel barriers when identified; assists with troubleshooting to reduce impact of uncontrollable barriers; notifies clinical manager/director/office coordinator throughout timeliness process.
9. Achieves highest level of clean claims through both direct and coordinated error corrections, and maintains, smallest possible baseline volume of errors; monitors and accumulates error data by clinician, error source, and timeliness of correction; identifies trends in errors among staff and provides or coordinates ongoing training for staff.
10. Provides and documents clinic electronic data protocol in consultation with clinical and information system staff; seeks to improve electronic data integrity through coordination with internal and external Clinical, IS, and Claims staff by identifying issues, requirements, and needs around utilization of the electronic system and office flow of work.
11. Familiarized with maintaining client integrated health records and administration, including; coordinate with office administration/integrated health records staff and clinical staff to ensure proper documentation of client records.
12. Attends internal and external meetings as assigned.
13. Operates a variety of office machines and equipment, including but not limited to personal computer, fax machines, copiers and postage machines.
14. Maintains client confidentiality in compliance with HIPAA.
15. Assist in special projects as required by Director of Claims and Quality Management.
16. Utilize ClaimTrak to bill for services for RBHA and other plans as contracted.
17. Meet department goals.
18. Perform other duties as assigned.

JOB DEMANDS:

Ability to manage large groups of electronic data on a routine basis. Ability to communicate clearly and effectively both verbally and in writing. Able to present operational information to personnel at all levels. Able to multitask and apply time management skills in a high volume environment. Ability to travel statewide as needed.

CONTINUOUS EDUCATION:

Employee will be expected to participate in continuous learning, competency building and maintenance of competency skills.

TYPICAL WORKING CONDITIONS:

Work is performed in structured environments.

ACCOUNTABILITY:

Reports to and is supervised directly & administratively by Director of Claims and Quality Management. Employee is also accountable for understanding and complying with CPLC policies and procedures.