ABOUT THE POSITION
OCU is seeking an experienced Billing Specialist to lead the insurance billing processes for our school- and community- based behavioral health clinical services. The Billing Specialist is responsible for preparing and submitting timely and accurate insurance claims to third party payers and is responsible for appropriate follow up on all accounts pending payment from government and third-party payers. The Billing Specialist supports the implementation of payer regulations, ensuring compliance with regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract, or other regulations or agreements. The Billing Specialist reports to the Director of Finance. This is a part-time, virtual position, with occasional trips to the office.
RESPONSIBILITIES INCLUDE:
- Prepare and electronically submit clean claims to various insurance companies.
- Research any paid claims not consistent with the original claim, make any corrections and necessary updates and appropriate adjustment documentation.
- Process any updated information for claims to ensure timely payment.
- Research each denied claim and re-bill accordingly.
- Post payments to the client’s accounts and ensure appropriate allocation.
- Complete monthly billing reports.
- Retrieve missing intake information.
- Update client benefit, demographic, and insurance information as needed.
- Review and post denials to accounts to ensure accurate payment status and account activity.
- Monitor aging reports and take necessary actions to guarantee payments of claims.
- Review accounts and make phone calls to assigned insurance groups for insurance follow-up to determine claim adjudication.
- Identify payments or adjustments that require review by insurance companies. Take necessary actions (i.e., send letters, initiate phone calls, or obtain medical records) to prepare a review to send to the insurance company. Track the account until the correction is made.
- Assure compliance with applicable billing laws and regulations to maximize cash receipts.
- Contact insurance carriers regarding non-payments and/or improper payment on claims.
- Identify problem accounts with payers; investigate and correct errors, follow-up on missing account information, and resolve past-due accounts.
- Prepare reports to identify and resolve accounts receivable.
- Prepare, review, and send client statements.
- Answer inquiries by phone regarding past-due accounts and insurance guidelines; research incorrect addresses for past-due accounts.
- Assist with negotiating insurance contracts.
- Responsible for reading and understanding various types of Explanation of Benefits.
- Keep the supervisor informed of areas of concern and identified problems.
- Assist with annual financial audit.
- Maintain strict confidentiality regarding confidential conversations, documents, and files.
- Participate in educational activities and attend monthly staff meetings.
- Adhere to all HIPAA guidelines/regulations.
- Perform other duties as assigned.
QUALIFICATIONS
- Three (3) years experience in medical insurance billing
- Advanced knowledge of behavioral health codes
- Extensive knowledge of official coding conventions and rules
- Completion of program in medical billing or certification program preferred
- Thorough knowledge of coding and billing practices, A/R management and insurance requirements
- Associates degree or higher level of education preferred
- Experience with QuickBooks Desktop accounting software
- Knowledge of insurance collections or claims follow up required
- Proficiency with Microsoft Excel and/or Google Sheets
- A commitment to and understanding of One Common Unity’s mission
- A strong understanding of guidelines related to HIPAA, OIG, compliance, medical coding, billing behaviors and practices
- Excellent oral, written, and telephone communication
- Excellent computer skills, including Excel, Microsoft Word, etc.
- Able to work independently with minimum supervision
- Able to thrive in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs
- Well-organized and highly attentive to detail
Salary Range for this position: $40k – $80k/year ($18-38/hour) based on experience.