1ST SHIFT MONDAY-FRIDAY 8AM-5PM
WAGE: $17.10
Position Summary:
Under the supervision of Business Services Manager, prepare and submit claims for optimal reimbursement on client accounts for behavioral health services. Analyze outstanding accounts receivable and take appropriate action to resolve issues in preventing, delaying, or reducing appropriate payment. Conduct administrative support services including greeting visitors, answering phones, screening and routing calls, and scheduling. Respond to inquiries and requests from various sources related to client accounts and account processing. Complete new Provider Enrollment & Medicare revalidation.
Essential Duties and Responsibilities:
- Adhere to all laws and regulations pertaining to client health, safety and medical information.
- Process client claims, manual claims and special clinic billing. Review claims for irregularities, accuracy and completeness. Ensure claims meet all payer requirements for submission. Submit claims on a timely basis.
- Resubmit claims if payment is not received.
- Complete daily billing report verifying report with daily schedules and grouping clients by insurance group/pre-determined category.
- Perform demographic data entry; ensure data accuracy in medical billing system.
- Prepare and audit billing reports, correcting errors, and transmitting daily claims.
- Maintain all documentation for retention of claims documentation and reports.
- Complete end of the day reporting: financial, daily activities, deposits, system summary, etc.
- Perform billing/claims accounts receivable activities including: entering payment, maintaining deposit log, preparing documentation for Tribal Accounting, etc.
- Analyze outstanding accounts; take appropriate action to secure prompt and accurate payment of all claims submitted; resolve issues preventing, reducing, or delaying payment.
- Prepare documentation for monthly and year end close out.
- Coordinate, maintain and update documentation for all Behavioral Health Program providers to ensure compliance with licensing and timely claims processing.
- Perform routine configuration updates (procedure/diagnostic codes, fee changes, etc.) to billing software system.
- Perform troubleshooting and back up of data.
- Update manuals and stay current with billing changes.
- Maintain current knowledge of compliance policies and procedures, billing, and claims processing.
- Process newly hired providers and revalidate current providers’ enrollment into Medicare, BCBS, Medicaid and commercial insurances and CAQH enrollment. Ensure the provider is registered with billing packages.
- Dispose of documents that are over 7 years old according to established guidelines.
- Adhere to client confidentiality and comply with clinic policies and federal regulations under the Privacy rules of the Health Insurance Portability and Accountability Act (HIPAA).
- Provide excellent customer service for all internal and external customers of the operations at all times. Provide solutions for customer concerns and continually focus on customer service as our top priority.
- Perform routine clerical duties such as filing, photocopying, faxing, scanning, archiving, and operating office equipment.
- Provide assistance and/or coverage for other department administrative support employees, as appropriate.
- Answer phone, screen calls, and transfer to appropriate person or take messages when necessary.
- Must maintain strict confidentiality and present a positive, professional demeanor and image at all times.
- The above duties and responsibilities are not an all-inclusive list but rather a general representation of the duties and responsibilities associated with this position. The duties and responsibilities will be subject to change based on organizational needs and/or deemed necessary by the supervisor.
Contacts/Purpose of Contacts:
- Contact with department staff, managers and outside sources to plan, organize and coordinate work activities.
Minimum Qualifications:
- High School Diploma or GED.
- Must be 18 years of age.
- Must possess an Associate’s Degree for Medical Billing and Coding Professional from either the American Academy of Professional Coders (AAPC) or the National Healthcare Association (NHA).
- Two years of medical and/or behavioral health billing experience after obtaining the Associate’s Degree described above.
- Good accounting skills to maintain ledgers and accounts receivable and collection efforts.
- Proficient with Microsoft Office Suite of software.
- Must be able to pass background check to meet the employment eligibility requirements as they pertain to the position.
License, Certification, or Special Requirements:
- Ability to obtain HIPAA Certification, Blood Borne Pathogens Certification, and Safety Training within thirty days of hire.
- Native American preference shall apply to all positions.
Knowledge, Skills, and Abilities:
- Knowledge of insurance claims procedures and documentation.
- Knowledge of billing procedures.
- Skill in operating business computers and office machines, including in a Windows environment, specifically Word, Excel, Access, and PowerPoint.
- Skill in account balancing and records maintenance.
- Skill using inventory and accounting software.
- Ability to interact and communicate with people over the telephone, often in stressful situations.
- Ability to communicate effectively, both orally and in writing.
- Ability to verify data input and correct errors.
- Ability to gather data, compile information, and prepare reports.
- Ability to use independent judgment and to manage and impart confidential information.
- Ability to interact and maintain good working relationships with individuals of varying social and cultural backgrounds, employees and officials.
- Ability to understand and follow oral and written instruction.
- Ability to analyze and solve problems.
- Ability to meet strict time lines.
Physical Demands:
- Frequent use of hands, wrists, fingers associated with computer equipment.
- Required to sit for extended periods of time.
- Occasionally walk and stand.
- Normal visual acuity, ability to talk and hear.
- Occasionally lift and/or move up to 20 pounds.
Work Environment:
- Normal office environment.
- Extended hours and irregular shifts may be required.
