Specialist - Third Party Billing - Early Childhood Intervention/ECI -187 days 1/30

Job Title:                                     Third Party Billing Specialist – Early Childhood                                                            Intervention (ECI)

Reports To:                                  Program Supervisor

Period of Employment:               12 Months (187 days, 4 days a week) September 1                                                       through August 31 (Grant Funded Position)

Wage/Hour Status:                     Non-Exempt

Pay Grade:                                   AS03

Date Revised:                              05/2023

Qualifications:

High School Diploma or GED, including or supplemented by courses in business practices.

Knowledge of third-party billing practices.

Working knowledge of English, grammar, spelling and arithmetic.

Ability to work and communicate with people.

General office skills (organizing, filing, faxing, etc.)

General knowledge of billing processes for Health Maintenance Organizations (HMO’s), private insurance, Medicaid, CHIP, TRICARE and the Chronically Ill and Disabled Children’s Program (CIDC).

Ability to maintain confidentiality.

Primary Purpose:

The person should have knowledge of billing insurances or other health maintenance organizations, as well as invoicing and collection systems, and maintaining the records necessary to keep the information on these children up-to-date and in compliance with therapy services and assessments received at ECI Project TYKE.

Major Duties and Responsibilities:

1. Develop and implement processes to pursue third party billing.
2. Ensure all (HHS)ECI Third Party Billing, Family Cost Share and Maximum Monthly Fee standards are followed.
3. Enter new client insurance and cost share information.
4. Contact insurance companies or other health maintenance organizations to verify client’s benefits.
5. Complete, verify and maintain the credentialing for new staff with Medicaid Managed Care Organizations, Private Insurance Companies and Texas Medicaid & Healthcare Partnership.
6. Coordinate and provide the parents with information regarding benefits, if requested and explanation of benefits.
7. Maintain, develop and distribute forms used in the operation of third-party billing.
8. Invoice Family Cost Share on monthly basis for all enrolled ECI clients and document collection of payment.
9. Invoice private and public insurance on a monthly basis for all enrolled ECI clients and document collection of payment.
10. Maintain and update daily, weekly, monthly all ECI clients’ financial records based on billed and received insurance and Family Cost Share invoices, payments, EOB’s, etc.
11. Oversee the scope and sequence of third-party billing processes for the various insurance organizations.
12. Collaborate with individual insurance representatives when benefits are denied adhering to the process and or corrections to billing to ensure payment of ECI services.
13. Monthly verification of Medicaid eligibility and update verified information in program and state databases. Notify staff members of eligibility changes to ensure quality billing of services.
14. Report the collections from third party sources on a quarterly basis to (HHS)/ECI.
15. Complete and submit reimbursement requests to corresponding third party sources.
16. Establish an accounting system for documentation of third-party reimbursements.
17. Communicate with program staff regarding client’s third-party benefits.
18. Maintain quality of third-party billing data as entered into local and state database system. Ensure that all insurance data and Family Cost Share data for all clients is quality and accurate data.
19. Correspond with child’s physician or office staff to establish the necessity of medical services.
20. Coordinate, collaborate and communicate with local database support contractor to ensure updates, issues and/or technical assistance.

Equipment Used:

Personal computer, printer, copier, calculator, fax machine, multi-line phone, laminator, phone headset.

Working Conditions:

Constantly operates a computer and other office productivity technology; Repetitive hand motions such as prolonged use of the computer and or calculator; Must be able to remain in a stationary position at least 50% of the time; Frequent sitting, stooping, bending; Light lifting and carrying, 15 pounds daily; maintain emotional control under stress, work with frequent interruptions.

The foregoing statements describe the general purpose and responsibilities assigned to this job and are not an exhaustive list of all responsibilities and duties that may be assigned or skills that may be required.