Billing Specialist
Fairfield, Ohio
Reports to: Director of Finance
Agency: Community Health Alliance
FLSA Classification: Non-Exempt
Hours:Benefit Eligible:
To provide a safe, secure and professional environment for clients and staff, Sojourner employees are required to:
Take all steps and precautions possible to maintain and ensure client confidentiality.
Maintain appropriate professional boundaries when interacting with clients and fellow coworkers.
Maintain all necessary documentation as required by OMHAS, CARF, and your professional license, and do so in accordance with Sojourner Policies and Procedures.
Maintain, in good standing, any professional license required for you to perform your job.
Embrace the Sojourner Mission, Vision and Beliefs, and support a positive, pro-social, drug-free environment for our clients.
Summary
Review all Sojourner billings for accuracy on a weekly basis, edit and submit for revisions as necessary.
Job Duties and Responsibilities
Thoroughly review and understand Explanation of Benefits (EOBS)
Thoroughly understand claim denials and proper steps to resolve issues.
Utilize payer websites and dedicated call centers for claim status and to review claims submitted.
Call insurance companies regarding any discrepancy in payments as necessary.
All accounts are to be reviewed for insurance or patient follow-up.
Review and follow up on claim denials timely and take appropriate actions to resolve claims.
Review claims submitted for accuracy and submit corrected claims as needed.
Update demographic and insurance information in the billing system.
Provide feedback on payer trends and issues prohibiting proper payments to Director.
Provide feedback on claim payments to ensure the fee schedule is accurate.
Maintaining notes on each claim worked in a clear and concise manner. Properly note all steps taken.
Skills
Excellent customer service skills.
Strong written and verbal communication skills.
Knowledge of
Filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
Responsible use of confidential information.
Ability to
Manage relationships with various Insurance payers.
multi-task and work courteously and respectfully with fellow employees, clients and patients.
multi-task and work courteously and respectfully with fellow employees, clients and patients.
Knowledge of
CPT and ICD-9 coding; familiarity with medical terminology.
Professionalism
Establishes a rapport, maintains clear professional boundaries and focuses on assignment/task completion with staff.
Balances and prioritizes responsiveness to multiple staff and tasks.
Produces documents, reports, correspondence, etc. that are accurate and promote a professional image.
Works with consumers and staff in an ethical, culturally sensitive and respectful manner.
Gives and receives constructive feedback that promotes teamwork, professional growth and job performance.
Education & Experience Required
High school diploma.
Minimum of 3-5 years of substance abuse and mental health billing and follow up experience.
Strong understanding of working accounts including, MCO, Medicaid, PPOs Medicare
Recent experience working on payer websites to look up claim status, submit appeals,
Recent experience working accounts including billing, collections, denials, and appeals.
Ability to calmly handle multiple tasks at once.
Carelogic experience preferred.
Supervisory Responsibility
None
Travel
Limited to off-site training