Billing Specialist

SUMMARY

This Billing Specialist position is responsible for correcting, completing, and processing service claims for all payer types. He / She is also required to generate reports from both the billing system and the clearinghouse system in accordance with established procedures. This person has public contact of a limited scope, involving routine and standard information exchange with payers, the clearinghouse, client responsible parties and other employees when necessary. This person reports to the Billing Manager.

GENERAL RESPONSIBILITIES

• Contributes to creating a welcoming and inclusive environment for our clients, colleagues and community partners from diverse backgrounds and experiences.
• Integrates principles of Trauma Informed Care in all aspects of work.
• Is sensitive to the children’s culture and socioeconomic characteristics that delivers the best possible care to the youth and families served.

MEDICAL BILLING

• Weekly review of all validation reports before claim submission.
• Send electronic billing file(s) for all claim payers on weekly basis or other time frame as established by the Finance Team.
• Weekly rework claim errors on all payers in order to expedite payment of the erroneous claims.
• Enroll new and returning clients with local board(s) to gain access to public funding for service payment.
• Upload electronic payment files, reviewing and working unpaid claims.
• Enter cash receipts and assure correct allocations and distributions in accordance with the established protocol.
• Adhere to monthly closing schedules set by the Finance team.
• Identify unbilled claims (on a weekly basis) and expedite the billing to avoid non-payment due to untimely filing (know the payer limitations.
• Locate missing Explanation of Benefits (EOB’s) for commercial insurance to appropriately move balances to the next payer.
• Rebill or re-adjudicate unpaid claims in all payer systems.
• Download / upload appropriate payer reports.
• Work with staff to enroll in payer networks.
• Other duties as assigned or requested.

EDUCATION BILLING

• Facilitates the enrollment of families in non-public school educational funding programs.

EDUCATION & EXPERIENCE

• High School diploma or equivalent is required.
• Minimum of 3-years billing experience is required.

TECHNICAL SKILLS

• Strong computer skills to include proficiency with Microsoft Office Suite (i.e. MS Word, Excel and Access).
• The ability to research and analyze various different types of data information.
• Ability to use standard office equipment such as copy/fax machines and printers.