Responsibilities

Essential Functions:

• Claims Submission: Generate and submit accurate claims to insurance providers (government and commercial) for reimbursement.
• Coding: Translate medical records and procedures into universal codes (CPT, DSM-5-TR, ICD-10-CM, HCPCS) to process claims.
• Verification & Authorization: Verify patient insurance coverage and secure pre-authorizations before services are rendered.
• Denial Management: Review rejected or denied claims, correct errors, and submit appeals to maximize reimbursement.
• Payment Posting & Collections: Process payments, reconcile accounts receivable, and follow up on outstanding patient balances.
• Patient Inquiries: Respond to patient questions regarding invoices, billing statements, and payment plans.
• Compliance: Adhere to HIPAA regulations, confidentiality standards, and data security procedures in all patient data handling.

Marginal Functions:

• Quality Assurance: Ensure accurate claims information, including patient data, diagnoses, and procedure codes.
• Efficiency and Timeliness: Ensure all claims are submitted on time to primary, secondary, and tertiary payers.
• Reporting: Produce and reconcile claims billing reports to support payroll and performance management.
• Customer Service: Communicate with clients and external stakeholders.
• Collaboration: Collaborate with colleagues and support operational redundancy through cross-functional training.
• Fraud and Waste Prevention: Minnesota Health Care Programs (MHCP) prohibits individuals or entities found guilty of fraud, abuse, or program misconduct from participating in or receiving Medicaid funds. Screen employees and contractors monthly against the federal and state excluded provider lists.
• Other duties as assigned.

Required Skills and Qualifications

• Experience: Previous work experience in medical billing, insurance verification, or front office administrative jobs in mental healthcare facilities.
• Detail-Oriented: Ability to detect errors in billing data to avoid claim denials.
• Technical Proficiency: Experience with electronic health/medical record (EHR/EMR) software and medical billing software (Empathic Clinical Software preferred).
• Knowledge of Coding: Familiarity with procedure codes, including the Current Procedural Terminology (CPT), and demonstrated understanding of terminology and coding procedures.
• Communication Skills: Strong written and verbal skills for communicating with patients and insurers.
• Education: A high school diploma or GED is required.
• Fraud and Waste Prevention: Candidate must not be included in the List of Excluded Individuals/Entities (LEIE) or the Minnesota Excluded Providers List.

Preferred Skills

• A certificate in medical billing and coding or comparable experience is strongly preferred.
• Understanding of privacy laws such as the Health Insurance Portability and Accountability Act (HIPAA) and how to protect patient data.
• Inclusive values and experience working with the neurodivergent community.
• Commitment to diversity, equity, inclusion, and disability justice.
• Self-motivated to work independently.
• Demonstrated good judgment and cultural competence to support communicating with a diverse range of individuals.
• Excellent Mac computer skills, including Microsoft applications (Word, Excel, Outlook, PowerPoint).

Position Details

• St. Paul, MN
• Full-time, non-exempt
• Monday - Friday
• Hybrid position with remote work and two in-person days per week.
• Flexible schedule with occasional evenings and weekends.
• Comprehensive benefits include:
  • Flexible work schedule in a hybrid work environment.
  • Health, dental, and vision insurance.
  • Optional health savings account (HSA), or flexible spending accounts (FSA) for health or childcare costs.
  • Basic term life insurance.
  • Short- and Long-term disability insurance.
  • 401k retirement plan.
  • Up to 35 days off per year (15 vacation days, 6 sick days, 12 holidays, and 2 personal days).
• Opportunities for advancement.

About the Autism Society of Minnesota