Billing Support Spec. III

Statement of Purpose

The Billing Support Specialist III understands the duties of the Billing Support Specialist I and II, while also providing additional support with in-depth research, escalation, documentation, and communication with Management. The Specialist III would also understand the underlying system data and be able to generate detailed analytical reports as needed by Management.

Major Tasks, Duties and Responsibilities

• Have a working knowledge of EDI Billing files including the definition and use of TA1, 999, 277, 835, and 837 files.
• Be able to diagnosis and correct commonly known issues for claims that are either not transmittable ("Held" and "Missing" claims) or have been 277CA rejected or 835 denied by the MSO. Work with Clinical or Admin staff to resolve all issues.
• Be able to access and navigate MSO systems for relevant information. Be able to submit Cases or Tickets with the MSO for additional technical support. Follow up with issues until they are resolved.
• Maintains knowledge of claim requirements for contracting agencies (SAPC, DMH, LAC, ACRO-Cal, etc.) and other third-party payers.
• Maintain knowledge of State and Federal resources to aid in the investigation of Level 2 Denied Claims
• Record, document, maintain and distribute metrics regarding claims activities (errors, submissions, payments, etc.) required by management and third-party regulatory agencies and contracts
• Be able to understand and organize large data sets for financial/operational analysis per the parameters requested by Management or outside regulatory agencies (SAPC, DMH, etc.)
• Assist in the maintenance of the EHR system (myEvolv) Rate Tables and help provide minor technical assistance as needed
• Assist supervisor with any special tasks, projects or events.
• Other duties as assigned.

Competencies and Performance Expectations

• Data Analytics
• Ability to juggle multiple tasks.
• Critical thinking skills. Be able to clearly explain error issues and steps taken.
• Ability to provide analytical summaries based on large data sets
• Solution oriented and proactive approach to billing process.
• Ability to maintain tactful discretion, confidentiality and compliance with Health Insurance Portability and accountability Act (HIPAA).
• Strong verbal and written communication skills to establish and maintain effective working relationships with payers and staff.
• Proficiency in Microsoft Office suite, specifically Excel.
• Ability to work with peers in a team situation
• Ability to convey respect for cultural and lifestyle diversities of all when interacting on behalf of the agency, recognizing personal biases working with diverse populations.
• Proficiency or ability to rapidly gain proficiency in use of electronic health record (EHR) technology
• Must be able to speak, understand, and communicate in English