What are the responsibilities and job description for the Insurance and Billing Specialist position at Cutchins Programs for Children and Families, Inc.?
Position Summary - Hybrid Role Located in Northampton, Mass.
Performs a variety of credentialling, insurance, contractual, and billing related duties for the Children’s Clinic. Manages the insurance verification and billing/payment process, as well as all paneling requirements for staff that complete billing. Facilitates and oversees the timely credentialing and revalidation processes for individual providers, as well as the Agency and Clinic. Develop and maintain collaborative relationships with all staff at the Children’s Clinic, business office, clients, and insurers to ensure coverage, authorizations, and efficient and timely processing of all billing. Maintain positive relationships with external parties, such as trade organizations, contract managers, Quaifacts staff, and insurance company liaisons.
Essential Position Functions
1. Responsible for Client Insurance verification and the initial set up and maintenance of client file and insurance information, including opening new client charts in the EHR, adding insurance information to the chart, and closing terminated charts in EHR.
2. Form building and ticket requests to Credible EHR as needed.
3. Responsible for initial insurance verification/determination of benefits/limits of service as well as ongoing determination of insurance eligibility. Communicate with billing and clinical staff on insurance/benefits issues. This includes: advance calling of client for insurance information, pre-verification of client insurance coverage as well as daily insurance verification via EVS system (Medicaid) and phone (Commercial insurance).
4. Submit and follow up on all billing in a timely manner. This may include electronic requests and paper billing.
5. Act as a conduit for insurance information within the Clinic and as a liaison between the clinical staff and the billing/accounting dept.
6. Complete and follow up on various Fiscal duties including but not limited to: running Aging Reports to follow up on missing/overdue payments, billing statements sent to families, phone calls for pursuit of delinquent payments.
7. Closely collaborate with Children’s Clinic Administrative Assistant on any duties related to EHR, billing, pre-verification of clients, and contracting.
8. Complete and oversee insurance panel development and updating as necessary, including managed care panels, getting information on contracts, fee schedules, and detailed information on how the specific managed care panel works to present to the Children’s Clinic Director.
9. Keep current on all changes to insurance and contractual agreements that may impact billing and other areas of responsibility.
10. Maintain skills in the electronic health record system, proactively seek out training in areas of need and/or interest.
11. Obtain and maintain skills in the electronic health records systems (i.e., running reports, building forms, billing interface, etc).
12. Paneling new Clinicians with all relevant insurance companies and keeping current clinicians' paneling up to date, using individual company protocols and CAQH.
13. Submit billing to any non-insurance-based payors, such as DCF through the Virtual Gateway.
14. Regular outreach to all Clinic families to ensure all information in EHR chart is current and updated.
15. Enroll Clinic Clinicians in CANS approved virtual site (such as the Virtual Gateway) as Cutchins Employees.
16. Attend any required meetings and trainings, including but not limited to ABH billing meetings. Report back to Clinic Director and Fiscal team with relevant information/updates via minutes of meetings.
17. Adhere to Cutchins Programs for Children and Families Rules, Standards, and Ethics Policy.
18. Adhere to Cutchins Programs for Children and Families Privacy Practices
Minimum Requirements for the Position
Degree: Associates/Bacherlors Degree preferred.
License /Certification: None
Years and Type of Experience: 3 years equivalent experience in Billing/Insurance
Other: Must be a Mass. resident to work for this Mass. based organization. Days in office vary.
Other Skills or Requirements: Good verbal and written communication skills, excellent interpersonal skills, knowledge of various computer programs and Platforms (Word, Excel, Google, Virtual Gateway etc.)., Experience with Electronic Health Records (EHR), Knowledge of Credible highly preferred. Valid driver’s license.
Physical Requirements: Visual acuity to written and computer screen data, manual coordination and dexterity in the operation of office equipment.
The description above represents the most significant and routine duties of the position but does not exclude the performance of other assigned duties or projects consistent with its essential functions and minimum requirements.
Cutchins Programs for Children and Families promotes an equal employment opportunity workplace which includes reasonable accommodation of otherwise qualified disabled applicants and employees.
Job Type: Full-time
Pay: $22.00 - $24.00 per hour
Expected hours: 40 per week
Benefits:
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
Salary : $22 - $24