JOB SUMMARY: The Billing Specialist performs clerical, billing procedures, and administrative tasks to optimize client and customer experience in the day-to-day operations of the business or program office to which they are assigned while ensuring that services provided are in alignment with the Social Determinants of Health through a trauma informed care lens as defined by the agency - Verify client insurance eligibility, benefits, and authorization requirements prior to service.
- Review clinical documentation to ensure completeness and compliance with billing requirements.
- Prepare, submit, and track claims to Medicaid, Medicare, managed care organizations, and commercial insurance carriers.
- Monitor claim status and follow up on unpaid, denied, or rejected claims in a timely manner.
- Research and resolve billing discrepancies, claim denials, and payment issues.
- Post insurance and client payments accurately and reconcile billing records.
- Maintain accurate client demographic, insurance, and billing information within the Electronic Health Record (EHR) and billing systems.
- Generate and review billing, accounts receivable, and reimbursement reports.
- Communicate with insurance companies, clients, and staff regarding billing inquiries and payment issues.
- Collaborate with clinicians and program staff to ensure documentation supports billing and reimbursement requirements.
- Assist with audits, compliance reviews, and reporting requirements as needed.
- Maintain confidentiality of client information in accordance with HIPAA and organizational policies.
- Stay informed of changes in billing regulations, payer requirements, and reimbursement guidelines.
- Assigned Front Desk (Suite 103) lunch coverage, desk coverage
ESSENTIAL PERFORMANCE REQUIREMENTS: Required Competencies/Skills: - Professionalism and Ethics: The demonstration of ethics and sound professional practices, as well as stimulation social accountability and community stewardship. The desire to act in a way that is consistent with one's values and what one says is important.
- Financial Skills: Ability to understand and explain financial accounting information, prepare and manage budgets.
- Critical Thinking and Analysis: The ability to assess the authenticity, accuracy and worth of knowledge claims, beliefs, or arguments and reaching sound conclusions based on observation and information.
- Performance Measurement: The ability to understand and use statistical, economic, epidemiological and financial methods and metrics to set goals and measure clinical as well as organizational performance; commitment to and employment of evidence-based techniques.
- Healthcare and Human Services Environments: Ability to explain issues and advancements in the healthcare and human services industries.
ESSENTIAL FUNCTIONS: Agency Functions: - Community and Customer Service - Increase client access, enrollment, and satisfaction of program resources by creating wraparound services, recruitment, and surveying strategies.
- Internal Processes - Use agency and program data to track clients through different agency programs to gauge resiliency and outcomes of participating families.
- Learning and Growth - Strengthen staff and client well-being by addressing the social determinants of health: Economic Stability, Education, Health and Healthcare, Neighborhood supports, Social and Community Engagement.
QUALIFICATIONS: To perform this job satisfactorily, an individual must be able to perform each essential performance requirement satisfactorily. The requirements listed below are representative of the training, experience, knowledge, and skills required for this job. Reasonable accommodation may be made to enable an individual with disabilities to perform the essential functions listed above. Education/Training/Experience: - High school diploma.
- 1-2 years of medical billing, and behavioral health billing, or healthcare revenue cycle experience.
- Experience working with Medicaid, Medicare, commercial insurance, and managed care organizations preferred.
- Experience in a nonprofit healthcare or behavioral health setting preferred.
- Basic understanding of medical billing and coding process.
- Knowledge of insurance verification, claims submission, payment posting, denials, and accounts receivable follow-up.
- Familiarity with HIPAA regulations and confidentiality requirements.
- Understanding of behavioral health documentation and billing requirements preferred.
- Proficiency in Microsoft Office applications, particularly Excel, Word, and Outlook.
Preferred Qualifications: 1. Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Accounting, Finance, or a related field. 2. Twoo (2) or more years of experience in behavioral health, mental health, substance use treatment, or nonprofit healthcare billing. 3. Experience billing Medicaid, Medicare, managed care organizations, and commercial insurance plans. 4. Knowledge of behavioral health billing regulations, authorization requirements, and documentation standards. 5. Experience with Electronic Health Record (EHR) systems and practice management software. 6. Bilingual in English and Spanish preferred. 7. Ability to work independently while maintaining effective collaboration with clinical, administrative, and finance terms. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - While performing the duties of this job, you must be able to stand, walk, reach with hands and arms, climb or balance, stoop, kneel, crouch or crawl, talk and hear, and taste or smell.
- You may be able to lift up to 10 pounds, have close vision, color vision, depth perception, and ability to adjust your focus with good hand-eye coordination.
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