REQUIRED JOB SPECIFICATIONS
- Education & Experience
- Billing Specialist I (Entry Level)
- High School Diploma.
- Coursework in Medical or Dental Billing OR Minimum of One (1) year of experience in Medical/Dental Billing including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files OR a combination of coursework and experience.
- Billing Specialist II (Senior Level)
- High School Diploma.
- Associates degree in Medical or Dental Billing OR Minimum of two (2) years’ required and 3 years’ desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience. OR a combination of coursework and experience.
- Billing Specialist III (Senior/Certified Level)
- Associate degree and/or Billing Certificates (CPC, RHIT, RCC).
- Minimum of three (3) years required and 5 years’ desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience.
- Licensure: Level II (Senior Certified) – Certifications (CPC, RHIT, RCC
- Knowledge:
- Level I: Knowledge of processing and following through on Explanation of Benefits (EOB) and ERA files including payments and Rejections.
- Level II &III: Knowledge of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines. In depth knowledge of rejected claims and payor guidelines which includes minimal resubmissions, corrected claim submissions, appeals and understanding timely filing limits. Medicaid and Medicare billing experience is required.
- Skills: Strong data entry skills; ability to input a high-volume information accurately. Adept math skills with strong ability to perform reconciliation functions. Organized and detail oriented. Must have good computer skills, proficiency with Outlook, Word, and Excel. Proficient 10 key skills. Bilingual (English/Spanish) preferred. Demonstrates strict adherence to HIPAA guidelines. Expertise in working rejections to resolve issues and obtain timely payment of claims independently. Ability to multi-task and provide a high level of productivity while maintaining accuracy. Must be able to work under pressure. Understand collection process. Desire to learn and master new things, seek help when needed and willingly assist others in time of need. The Senior level will have to show that they have mastered the skills above and are able to move to the next level meeting criteria of next level as described above.
- Abilities: Trainable and able to follow specific instructions. Ability to communicate effectively with other staff, patients, and management. Able to work with limited supervision and keep current with all job duties. Senior Level staff must show that they have the ability to move to the next level assisting Director in duties as needed and can work with no supervision and are willing and able to take on more responsibilities in the department. Ability to treat everyone with respect.
- Physical Effort: Must be able to sit, stand, and or walk for an entire workday. Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs. occasionally.
- Hours of Work: Full-time. Flexible and varied.
- Travel: Extensive local travel between sites. Occasional seminar travel. Mileage and travel reimbursement according to GLBHC travel policy.
