Medical Billing Specialist

Determine initial eligibility and benefits for applicant

·         Determine if any pre-authorization or pre-certification is required under their benefit plan for the SUD related services

·         Enter authorization tracking received from Chief Clinical & Health Officer in Insync.

·         For insured patients, Billing Specialist will perform a pre-service eligibility & benefits review including a determination of pre-authorization needs and/or admission notification requirements as applicable prior their 1st appointment.

o    Will prepare a Financial Agreement for the patient and distribute the agreement to the front desk staff for signature at check-in for their 1st appt.

o    Will notify the Chief Clinical & Health Officer of any required pre-auth or admission notice prior to the 1st appointment date and will facilitate informing and assisting the clinician with the pre-auth or admit notice process.

·         Meet in person prior to the first Assessment appointment for financial counseling when after pre-screening the patient that may be eligible for a nominal fee (uninsured-undocumented) or a sliding scale (uninsured-underinsured) agreement.

·         Review on a daily basis the batch eligibility reports generated in Insync 3-4 business days before their schedule appointment and contact any client that is found to be ineligible at that time so-as-to-be able to:

o    Obtain new insurance information and perform eligibility/benefit check or;

o    To facilitate enough time for the client to recertify their Medicaid benefits prior to the date of the scheduled service or Pay out of pocket for the services until recertification application proof has been supplied.

o    Review Date of Service eligibility report and notify front desk of any clients that are found to be ineligible on their date of service prior to their appointment time.

o    Perform the review of charges generated by the providers daily to ensure correct coding

o    Reach out to providers with any questions regarding their coding of services

Monitor services date to charges reporting to ensure all services rendered have been submitted for billing within 48 hrs. of service date (business days)

Monitor the Millin issue tracker daily and respond and correct information for claims that have been denied

·   Monitor outstanding AR reporting for unpaid claims, incorrectly paid claims, incorrect balances and rebill/resubmit claims coordinating as appropriate coordinating with the Millin account representative

·   Generate the appropriate monthly AR reports (to be defined) for management staff

·   Assist the front desk and clinical staff with any questions they may have related to billing, payment and eligibility as appropriate

·   Act as resource and mentors all staff and management on billing, coding and related questions that arise.

·         Assist Chief Clinical & Health Officer regarding any clinical or office related matters that she may request.

·         Management of the Assessment Tracker to monitor no shows, cancelations and rescheduling of assessments.