Medical Billing Specialist

Billing Specialist — Michigan (Macomb, Saginaw, St. Clair)

Compensation and benefits

• Starting Salary $50,000, commensurate with experience.
• Benefits: Medical, dental, vision; 401(k) with 4% match; paid time off and sick time; employer-paid short-term disability; group life; EAP; CEUs and professional development reimbursement; referral program; flexible scheduling; Supportive Administrative Back Office.

Role overview

• The Billing & Credentialing Specialist is responsible for provider enrollment, follow up with health plans until an effective date is obtained, maintaining excel spreadsheets on status and monitoring all CAQH data to be updated. This position also coordinates with clients on claims resolution due to enrollment issues. In addition, you will be responsible for reviewing medical records and insurance claims to determine the procedure code or diagnosis that best matches the medical service. You will determine if payment has been received from the patient and send notification to the insurance company. You will handle claims administration and reimbursements, making sure all claims are processed in a timely manner. This job requires excellent attention to detail, excellent computer skills and knowledge of medical terminology is essential.

What our Billing Specialist do:

• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing
• Obtain referrals and pre-authorizations as required for diagnostic reports, treatments, and therapy.
• Review client bills for accuracy and completeness and obtain any missing information.
• Follow up on unpaid claims within standard billing cycle timeframe.
• Check each insurance payment for accuracy and compliance
• Call insurance companies regarding any discrepancy in payments if necessary
• Identify and bill secondary or tertiary insurances.
• Research and appeal denied claims.
• Answering client or insurance telephone inquiries pertaining to assigned accounts.
• Setting up client payment plans and work collection accounts.
• Ensure that centers are in compliance with relevant regulations.
• Prepare, submit and follow-up on all initial payer applications in an accurate and timely manner.
• Review provider credentialing files and obtain any and all missing information.
• Contact and respond to any requests for verification of credentials.
• Ensure credentialing and licensing processes are completed and notifications sent out as needed.
• Maintain and update provider files and rosters
• Develop knowledge of insurance carriers and requirements.
• Establish and maintain relationships with insurance providers and credential personnel.

Requirements:

• At least 2 years experience in ABA Medicaid billing and Tebra
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Competent use of computer systems and software.
• Familiarity with CPT and ICD-10 Coding.
• Effective communication abilities for phone contacts with insurance payers to resolve issues.
• Customer service skills for interacting with clients regarding medical claims and payments, including communicating with clients and family members of diverse ages and backgrounds.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• A calm manner and patience working with either clients or insurers during this process.
• Knowledge of accounting and bookkeeping procedures.
• Knowledge of medical terminology likely to be encountered in medical claims.
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

You're perfect for the position if you:

• Minimum 2 years billing experience in a healthcare setting required
• Must have excellent computer knowledge of Patient Accounting systems
• Associates degree or equivalent; Bachelor’s degree in related field desired
• data entry accuracy
• tech savviness

Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies and experience and may fall outside of the range shown.

Billing Specialist

Job Types: Part-time, Full-Time

Commensurate with experience.

Why work for Autism Systems:

• Paid time off
• Flexible Schedule
• Professional development funds
• Positive and collaborative environment
• Supportive administrative back office

About Autism Systems

• Autism Systems is an assent-based ABA provider focused on evidence-based care, collaboration with families, and clinician growth in small, connected teams.

Equal employment opportunity

• We are an Equal Opportunity Employer and consider all applicants without regard to legally protected characteristics. We will provide reasonable accommodations as required by law.

How to apply

• Submit your resume and preferred location(s).

Pay: From $50,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Vision insurance

Work Location: In person

Salary : $50,000