What are the responsibilities and job description for the Medical Billing Claims Specialist position at ARISE Treatment Center?
Pre-Employment Requirements:
- Drug test.
- Criminal Background check – over one year since prior conviction
- TB skin test: Must have a test or provide proof of one within the past year.
- Must have a valid driver’s license with reliable transportation.
- Prefer bachelor’s degree in a human service field, finance, accounting, or business administration but not required. A combination of education and/or experience must equal 3 years.
- Required experience in Commercial and Medicaid insurance.
Position Summary: Responsible for overseeing the billing process for clients. The duties include processing payments on behalf of a client, maintaining organized financial records to aid reporting, and calculating bill totals by looking through previous financial statements.
Skill Sets: Maintain a supportive and encouraging working relationship with personnel and clients. Excellent verbal and written communication skills are required. Solid understanding of basic accounting principles, fair credit practices, and collection regulations. Calculate, post, and manage accounting figures and financial records. Data entry skills along with a knack for numbers. Hands-on experience in operating spreadsheets. Proficiency in English and in MS Office. Customer service orientation and negotiation skills. Maintain a high degree of accuracy and attention to detail.
Physical and Environmental Demands: Visual acuity and manual dexterity are needed for the required paperwork. Frequent talking and hearing are required when communicating with co-leaders, families, and other service providers. The physical demands are light with walking, standing, and occasional stooping.
Job Responsibilities:
1. Able to provide quality customer service to personnel, clients, families and stakeholders.
2. Helps maintain the health, safety and welfare of personnel, clients and stakeholders.
3. Ensure the agency is operating under CARF accreditation standards.
4. Ensure that state and federal licensure and regulations are being adhered to.
5. Make decisions in relation to day-to-day operations and consult with CEO o
6. Process accounts and incoming payments in compliance with financial policies and
procedures.
7. Perform day-to-day financial transactions, including verifying, classifying, computing,
posting, and recording accounts receivables data.
8. Reconcile the accounts receivable ledger to ensure that all payments are accounted for
and properly posted.
9. Verify discrepancies and resolve clients’ billing issues.
10. Assist with ASAM authorizations for all levels of care.
11. Verify commercial and Medicaid insurance utilizing the KYMISS and/or Availity systems.
12. Utilize the current EMR system to gather information for authorizations, billing issues, etc.
13. Manually rebill claims in the EMR system and/or Availity if needed.
14. Assist in verification of accuracy of CPT codes and modifiers.
15. Assist qualified clients in obtaining and maintaining insurance through the KYNET system.
16. Oversee all functions of billing including authorizations.
17. Bill and re-bill claims.
18. Follow-up with claims denials.
19. Assist with the development of financial reports.
20. Weekly, Monthly, Quarterly, and Annual reporting to ELC.
21. Ensure company policies and procedures are upheld.
22. Ensure that physicians and programs are in compliance with regulations.
23. Maintain all program licensing and credentialing.
24. Keep records related to insurance contracts and necessary staff credentials.
25. Communicate with staff and insurance companies regarding required documentation and changes to contracts or policies.
26. Evaluate and oversee all medical record requests and recoupment requests and respond in a timely manner.
27. Other duties as assigned
Job Type: Full-time
Work Location: In person