Billing Support Specialist II

Benefits:

• Health, Vision, and Dental Insurance
• Long Term Disability Insurance
• Basic Life and AD&D Insurance
• Employee Assistance Program
• 401K Plan
• Paid Holidays plus 1 Floating Holiday
• Paid Sick Time
• 2 weeks Paid Vacation Time

Statement of Purpose

The Billing Support Specialist II performs the duties of a Billing Support Specialist, while also providing additional post-EDI billing support, specifically in the research and resolution of MSO Level 1 and Level 2 Denied claims

Major Tasks, Duties and Responsibilities

• Generate 837 EDI billing files and respond to corresponding files/transactions (835 EDI files & other HIPAA transactions) according to defined schedules for each contracted payer. Saves and maintains PDF and .txt files for each batch produced. Updates statistical logs and reports.

• 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 by the MSO. Work with Clinical or Admin staff to resolve all issues.

• Elevate and communicate issues preventing the correction of unresolved claims (for new or unknown errors) to immediate supervisors and/or Divisional Leadership, as appropriate.

• 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 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

• Be able to work closely with Divisional Directors and Divisional Coordinators to resolve complex system and training issues to prevent and/or resolve billing issues

• 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

• Ability to juggle multiple tasks.

• Critical thinking skills. Be able to clearly explain error issues and steps taken.

• Solution oriented and proactive approach to the billing process.

• Ability to maintain tactful discretion, confidentiality and compliance with the 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

Prerequisite Qualifications

The following are the qualifications required to perform the essential functions of this position. Qualifications may be subject to modification based on the Americans with Disabilities Act.

• High school diploma or equivalency.

• Three to five years of experience in billing and/or healthcare is a plus but not required.

• Knowledge of Electronic Medical Records (EMR) and Electronic Health Records (EHR) systems

• Knowledge of ICD10, CPT/HCPCS Billing Codes

• Knowledge of the LA County and/or State of CA Appeals Processes

• Light to moderate lifting is occasionally required (less than 25 lbs.)

• Ability to sit at a computer terminal for an extended period of time.

• Ability to travel locally if needed.

• Occasionally bend, sit, stoop, and stretch

• Average computer skills; strong interpersonal, verbal and written communication skills; ability to remain alert.

• Must have valid California driver's license and liability insurance if driving a personal or company vehicle on BHS business.

• Vision, hearing, manual dexterity, and eye-hand coordination must be adequate for the performance of job duties. Able to sit at a desk, use a keyboard, write and physically perform other job duties.