Billing Specialist

SUMMARY: The Billing Specialist is responsible for all aspects of insurance and patient billing.

ESSENTIAL RESPONSIBILITIES AND TASKS:

• Facilitate timely and accurate pre-bill audit of billing system transactions.
• Prepare and submit error free claims to various insurance companies.
• Contact insurance companies to get authorization for patient services as necessary.
• Identify and resolve patient billing complaints.
• Count cash from PRC, prepare and balance DBR, enter into check log.
• Prepare, review and send patient statements.
• Prepare adjustments and rebills.
• Post and file EOBs as received.
• Respond to patient and colleague questions promptly and efficiently.
• Resolve billing issues by discussing contract with third-party payer; explaining insurance contract with patient; negotiating settlement.
• Maintain patient and invoice files by entering and adjusting data.
• Enter data accurately and efficiently into posting, charge input and authorizations.
• Provide billing information by collecting, analyzing, and summarizing third-party billings, accounts pending, and late charges data and trends.
• Verify that CPT, HCPCS and ICD-10 codes submitted to third-party payers are an accurate representation of the medical services rendered. Research any discrepancies noted prior to charge entry to ensure accuracy.
• Notifying the Billing Manager of any regulatory and compliance issues relating to inaccuracies or aberrant billing patterns discovered during the billing process.
• Achieve outcomes using methods that align with CODA's mission and values:
• Communicate accurately and positively about recovery and the use of evidence-based treatments.
• Use data and science to identify barriers, overcome obstacles, and inform decisions.
• Be financially responsible; avoid waste, document accurately, seek new opportunities to serve.
• Demonstrate compassion and respect for others.

SECONDARY RESPONSIBILITIES AND TASKS:

• Provide back up to Customer Service as needed.

REQUIRED EDUCATION, EXPERIENCE AND COMPETENCIES:

• Associate Degree in Accounting or Business OR three (3) years of experience in a related field.
• Two years' experience in a Medical Office setting.
• Experience with ICD-9, ICD-10 and CPT coding issues.
• Knowledge of MMIS and CIM (State Medicaid Reporting Systems).
• Knowledge of insurance companies and working AR appeals.
• Ability to convey a positive attitude and treat others with respect.
• Ability to take personal responsibility for the quality and timeliness of work, and achieve results with little oversight.
• Ability to diligently attend to details and pursue quality in accomplishing tasks.
• Ability to utilize both oral and written communications skills to effectively communicate with patients, co-workers, community resources, supervisors, and various other individuals encountered in the course of performing work while maintaining patient confidentiality and establishing professional rapport.
• Ability to operate a computer, utilize basic MS Office programs, and effectively navigate and maintain patient records in an electronic medical records system.

REQUIRED CERTIFICATIONS AND LICENSES:

• None.

PHYSICAL DEMANDS:

• Must be able to operate a personal computer, including reading from a computer monitor, keyboarding, and using a mouse.
• Must be able to reach, bend, and handle objects.
• Must be able to occasionally lift up to 25 lbs.

OTHER REQUIREMENTS:

• Consistent attendance and punctuality are required of this position.
• A negative result on all pre-employment, reasonable suspicion, and post accident drug screens.
• An acceptable criminal record as determined by DHS, the Oregon Administrative Rules, and the Oregon Revised Statutes; and no current supervised parole or probation.