The Billing Specialist II performs duties to prepare, compile, and submit claims. Must have knowledge of?payor requirements as well as a firm understanding of billing compliance for proper billing. Must be able to delegate tasks, provide guidance to team, and share knowledge as needed. A collaborative and mentoring mindset is crucial. This position requires an individual with an extraordinary level of attention to detail and the ability to multi-task, as this is a high volume fast paced environment.
Essential Duties/Responsibilities
- Work with Billing Department Manager to provide clear team goals, develop workflow for claim management and follow up, and provide guidance to team as needed.
- Compiles, reviews, and analyzes 837 claims prior to submission.
- Routinely reviews, revises, appeals, and follow- up on all denials and rejections.
- Communicate with Clients providing coverage details, explaining charges, and processing/posting client payments
- Compile and post 835 ERA’s and ensure daily posting reconciliation of billing team
- Communicate billing errors to providers as needed for claim revisions.
- Other duties as assigned.
Supervisory Duties (if any)
Job Qualifications
Knowledge, Skills, and Ability:
- Possesses intermediate computer skills including Word, Excel, and Outlook.
- Prior experience in medical or mental health setting is required.
- Possesses advanced interpersonal, organizational, and oral and written communication skills.
- Ability to work independently and efficiently while providing guidance to team as needed.
- Prior working knowledge of billing, HCPCS, CPT, and ICD-10 codes
Education or Formal Training:
- High School diploma or equivalent.
Experience
- Minimum of 6 years experience in medical billing and claims processing.
- Netsmart (Avatar) experience preferred.
- Leadership experience preferred, but not required
Working Conditions and Other Conditions of Employment
Working Environment:
This job operates in a fast-paced, professional office environment and routinely requires the use of standard office equipment such as computers, phones, photocopiers. The position may require travel to conferences, meetings and branch locations on a regular or intermittent basis. Work may involve moderate exposure to unusual elements, such as extreme temperatures, dirt, dust, fumes, smoke, unpleasant odors, and/or loud noises. In the health center environment, there is potential for contact with blood-borne pathogens and communicable diseases, as well as potential for contact with dissatisfied or abusive individuals. There could be interaction with persons who are mentally ill, disabled, elderly and emotionally upset.
Physical Activities:
These are representative of those which must be met to successfully perform the essential functions of this job.
This is a largely sedentary role but can involve standing or sitting for extended periods of time, bending at the waist, and using hands and fingers to handle and file papers or operate assigned equipment. While performing the duties of this job, the employee is regularly required to talk or hear. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus. Employee may also have to lift 10 to 25 lbs. unassisted.
Conditions of Employment:
- Annual TB, federally required drug screening, and Influenza vaccination or compliance with policy and procedure.
- Required possession of a valid state driver's license.
- Successful candidate must submit to and pass, post-offer drug screen.
