BILLING SPECIALIST

General Summary:

The Billing Specialist ensures the maximization of Agency cash flow through accurate and timely billing and collection practices. This includes maintaining the electronic billing systems, the production of management reports and communicating effectively with clients, payers, clinical staff, and management when needed.

Reports to Agency CFO

Office locations in South Portland or Windham with limited travel for meetings possible.

Specific Tasks:

· Work in conjunction with Day One’s Informatics Specialist to help ensure the Agency and its clinical staff are appropriately credentialled with MaineCare, Medicare, and other third-party payors as necessary.

· Stay up to date on all changes in third party payer or clearing house credentialling, authorization, and bill submission regulations, processes, and requirements. Maintain and update Day One billing system as appropriate.

· Ensure service authorizations from referral/admissions, intake, or clinical processes interface with billing to ensure timely payment and report authorization lapses as appropriate.

· Ensure efficient and timely billing of all services to maximize cashflow.

· Ensure the accurate posting of cash receipts using electronic or manual remittances and generate cash receipt reports as necessary.

· Conduct billing follow-up promptly, researching and mitigating denied claims to the extent possible. Produce denial reports as necessary.

· Accurately process and bill “balance after” amounts, produce and mail statements, and work with clinicians to ensure appropriate collection of self-pay accounts.

· Maintain accounts and process self-pay accounts in accordance with any Agency charity care or sliding scale policies.

· Ensure billing processes are in place to appropriately charge “no bill” grants or contracts where necessary.

· Generate and review aging accounts to assess risk and assist in the establishment and maintenance of bad debt and contractual adjustment reserves.

· Assist in the reconciliation of AR subsidiary ledgers to the general ledger as necessary.

· Work directly with clinical management as needed to promote effective billing and collection practices.

· Produce standard and ad hoc reports to support finance and performance improvement functions.