Billing Specialist

Summary:

Responsible for accurate and timely billing, claim follow up, denial resolution, self-pay financial assessments, and payment follow up for Medicaid, Medicare, managed care, commercial insurances and self-pay services using InSync by Qualifacts and the Inovalon clearinghouse.

Reporting Relationship:

Reports to the Billing Manager

Schedule:

Monday - Friday 10AM - 6PM , Subject to change based on program need.

Responsibilities:

Core duties and responsibilities include the following. Other duties may be assigned as needed.

• Verify participant’s eligibility for Medicaid, Medicare and private insurances
• Process Insurance payments to participant accounts in computerized system.
• Make sure all participants are pre certified, pre authorized, and authorization for participant SUD billing.
• Submit accurate electronic claims through InSync and Inovalon, the agency’s clearinghouse.
• Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
• Reviews remittance and payment information and identifies underpayments, recoupments, missing payments and posting discrepancies
• Responds to participant billing and statement inquiries.
• Makes recommendations to management for write-offs.
• Handles appeals and follow-up for managed care and out-of-network claims.
• Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
• Conducts financial assessments for self-pay participants in accordance with agency policies and established fee schedules.
• Explains self-pay responsibilities, payment expectations and available payment arrangements to participants.
• Monitors self-pay balances and follows up with participants regarding outstanding payments and agreed-upon payment plans.
• Maintains accurate documentation of financial assessments, payment arrangements, and participant communication and collection activity.
• Escalates delinquent accounts and recommends appropriate next steps to the Billing Manager.
• Works assigned A/R by age and timely-filing risk; documents all billing activity and follow-up dates; maintains billing and collection trackers; escalates unresolved barriers to the Billing Manager.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

• Bachelor’s degree or existing staff with over 5 years of experience.
• Knowledge of billing software, (Preferably EPACES, Insync and Inolvalon)
• Attention to detail
• Good record keeping skills, outstanding communication skills and excellent interpersonal skills
• Must have computer skills.

Other Skills/Abilities:

• Researches rejected, denied and unpaid claims; completes corrections, resubmissions, appeals and payer follow-up through resolution.
• Excellent judgment and discretion; ability to handle multiple priorities simultaneously, meet deadlines, and handle work-related stress is required.
• Friendly, courteous, service-oriented, professional, outgoing, and customer service oriented.
• Detail oriented while maintaining an extremely positive attitude.
• Must be able to work independently and productively with minimum supervision.
• Recognize problems, identify possible causes and resolve routine problems.
• Team player with a "can do" attitude that can work in a fast-paced environment.
• Ability to establish and maintain professional atmosphere for employees, participants and customers

Benefits:

We offer a comprehensive benefits package that includes health, dental, and vision insurance, paid time off, retirement plans, and additional employee perks.

• 15 Vacation Days Annually
• 12 Sick Days
• Floating Holiday 1 annually
• 401K retirement plan with 3% match after 90 days of employment
• Medical Benefits after 30 days of employment with Cigna
• Dental/Vision eligible after 90 days of employment
• Access to Gym/Weight Room
• Access to Boxing Ring
• Short Term Disability
• Life, Accidental Insurance available through Aflac
• Transit Chek for commuting expenses
• Legal Shield for legal services
• participant

Join Elmcor Youth & Adult Activities as a Billing Specialist and play a vital role in supporting the organization’s financial operations and ensuring accurate, timely, and compliant billing processes. In this position, you will help maintain the financial integrity of our programs by reviewing billing documentation, processing claims, resolving discrepancies, and collaborating with program and administrative teams to ensure services are properly documented and reimbursed.

If you are detail-oriented, organized, analytical, and committed to accuracy, we encourage you to apply today and take the next step toward a rewarding career with purpose. Join a team where your expertise directly supports the continued success of programs that make a meaningful difference in the community.

Pay: $55,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Parental leave
• Vision insurance

Work Location: In person

Salary : $55,000