Billing Specialist

The Billing Specialist participates in billing process and data entry design to insure billing and claim accuracy, regulatory compliance and maximum collection of revenue; works closely with the Billing Supervisor and responds to issues and concerns of the management team. The Billing Specialist I processes cash payment and posts payor remittances, and performs routine account receivables follow-up work. Work is performed under the general supervision of the Billing Supervisor and is reviewed primarily in terms of results obtained in claim submission timeliness and accuracy, and account receivables management. Work is subject to review through observation of efficiency, timeliness, effectiveness, accuracy and full regulatory compliance. The incumbent must function independently within policies and procedures.

The Billing Specialist I provides high quality information and support that enhances the overall quality of Directions For Living services, and creates positive interactions between staff, clients and other key stakeholders by insuring accurate and timely collection, processing and reporting of financial or compliance information.

DUTIES

• PRIMARY FUNCTIONS
  • Submits paper and e-claims on a minimum weekly basis and as often as required or as directed by the Billing Supervisor or designee.
  • Works in conjunction with the Access Coordinator to ensure accurate posting of services for funded clients (Pinellas County, Eckerd, TANF, etc.)
  • Creates invoices necessary for invoicing and reporting of services.
  • Maintains all necessary tracking reports.
  • Mails client statements on a minimum quarterly basis, preferably on a monthly basis, or as often as required or as directed by the Billing Supervisor or designee.
  • Reports in a timely manner all client and insurance billing, statement, and payment and reimbursement irregularities, omissions and/or errors to the Billing Supervisor, Providers, and other stakeholders for corrective action.
  • Identifies areas of billing, remittance and cash posting, claims submission and statement generation, and accounts receivables process improvements and submits recommendations to the Billing Supervisor, Providers, reimbursement staff and other stakeholders.
  • Implements and monitors all aspects of billing and reimbursement corrections, modifications and additions on an as needed basis.
  • Maintains relevant claim, self-pay and remittance data in the billings systems.
  • Updates CMS1500 and/or 837 claim form and remittances whenever such data is updated by the AMA, CMS or any other regulatory agency.
  • Works with Billing Supervisor to produce and maintain agency and provider enrollment and credentialing data.
  • Perform quality review of all claims, client statements, remittance and collection transactions processed through the billing system.
  • Works under the direction of the Director and/or Billing Supervisor in maintaining coding integrity (CPT4, ICD9/10 and HCPCS) in all relevant data systems including making corrections on claims and client statements, as needed, and reporting errors to the stakeholders;
  • Periodically reviews claims and statement process as well as remittance and collection posting processes for all accounts with open balances.
  • Advises the department head of any and all client payment, reimbursement and accounts receivable follow-up issues.
  • Evaluates and resolves system problems as it relates to client accounts.
  • Under the direction of the Billing Supervisor, updates accounts to ensure compliance with Federal, State, County and Municipal rules and regulations.
  • Reviews, coordinates, and updates all payor and client billing methodologies to insure an accurate, timely and compliant billing processes.
  • Recommends and implements, upon approval by the Billing Supervisor, all Medicare and Medicaid changes to claim submission and client billing processes.
  • Prepares meaningful monthly client account and remittance utilization and A/R reports.
  • Demonstrates continuous effort to improve client billing, claims submission, remittance posting and accounts receivables operations, decrease turnaround times, streamline work processes, and work cooperatively and jointly to provide quality seamless customer service.

QUALIFICATIONS

• Formal Education:
  • Some college education preferred.
  • Certification: Billing and Coding certification strongly desired
• Technical Skills
  • Proficient in Microsoft Excel, Word and Outlook.
  • Accurate keyboard / data entry skills
  • Legible handwriting, accurate spelling, punctuation, and grammar.
  • Basic computer literacy including Internet and Microsoft Office programs
  • Ability to easily learn new systems and programs
  • Communication and people skills
  • Must have a customer service approach and be able to deal with stakeholders assertively but respectfully when needed.
  • Must work well as a team member and be able to successfully integrate ideas from all sources into regular work requirements
  • To communicate clearly and distinctly in English both orally and in writing
  • Excellent organizational and time management skills.

EXPERIENCE & KNOWLEDGE

• Experience:
  • Minimum of 1-2 years of direct experience with Medicare, Medicaid, HMO and Third Party billing and remittance processes, preferably in mental health.
  • Strong knowledge of coding and billing processes.
  • Experience with medical or clinical billing software.
• Knowledge:
  • Strong knowledge of Florida Medicaid and the Medicare Part B programs in regard to billing, claim submissions, claims appeals, remittances, coding guidelines, statutes, rules and regulations.
  • Strong knowledge of EOB's, posting paper remits and ERA's (ANSI 835's) and payment posting.
  • Preferred knowledge of provider enrollment and credentialing process and requirements.
  • General office practices and procedures.
  • Alpha and numeric filing systems.
  • CPT, HCPCS and ICD-9/10CM coding terminology and usage and documentation requirements.

Current Openings for Billing Specialist Jobs at Directions for Living

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