Program Billing Specialist (69441)

Position: Program Billing Specialist

Exemption Status: Non-Exempt

Reporting Relationship: Manager, Revenue Cycle Management

Direct Reports: None

Work Environment: Office-Based

Position Summary

The Program Billing Specialist works with the clinical staff and managers of assigned programs to ensure services are authorized, documented, billed, and paid in a timely and effective manner. Maintains a cooperative relationship with all staff to ensure the best service is provided to the agency and acts as the point of contact for the clinical staff for assigned programs for any billing-related questions, problems, or data requests related to the assigned programs.

Essential Duties and Responsibilities

• Enters billing data from clinical documentation to generate accurate billing charges in accordance with funding source requirements.
• Reviews and verifies incoming clinical documentation for completeness, accuracy, and compliance with timeliness and payer-specific standards.
• Collaborates with manager/supervisor to ensure electronic billing charges and corrections are completed timely to support maximum reimbursement.
• Researches insurance claim denials, determines claim validity, and adjusts and resubmits claims through appropriate submission methods when warranted.
• Inputs and maintains billing-related data in billing systems in accordance with established procedures and controls.
• Maintains required performance data and billing and collections metrics.
• Ensures eligibility and billing exceptions identified in the 271 eligibility file and 837 billing file are corrected and updated in the billing system in a timely manner; follows up with clinical staff to resolve data issues prior to the next billing cycle.
• Proactively identifies, prevents, and assists in correcting CDC errors in PICIS, and supports staff in determining CDC status and appropriate corrective actions.
• Proactively ensures all required eligibility information is obtained and updated timely to support accurate billing and maximum reimbursement; communicates barriers to timely and accurate billing to appropriate management.
• Responsible for staying knowledgeable about and adhering to HIPAA regulations as well as other state, federal, and agency regulations related to confidentiality of consumer health information.
• Performs other duties as required and/or assigned by supervisor and/or executive staff.
• Responsible for notifying supervisors of any training deficiencies that impair the PBS's ability to perform their duties.