Billing Coordinator

Description

Description of Position:

The Billing Coordinator supervises the Billing Team, which is responsible for billing insurance claims to the Oregon Health Plan (OHP) Medicaid Open Card and Coordinated Care Organizations, as well as Medicare, commercial insurance, and private pay. The Coordinator oversees the claims processes of checking eligibility, submitting claims, processing payments, identifying billing discrepancies, resolving denials, and determining write-offs. The Coordinator is responsible for ensuring prior authorizations are in place and updating systems for fee schedule changes.

Essential Functions

Billing System Oversight (25%)

• Implement and maintain billing contracts with insurance companies in coordination with Practice Manager
• Liaison with Oregon Health Plan regarding Vision Service rules
• Attend insurance billing meetings
• Maintain billing systems with current fee schedules, covered diagnoses, prior authorization requirements, and CPT/HCPCS procedure codes
• Prepare month-end reports of all claim batches submitted
• Reconcile, maintain, and update billing denials lists
• Identify areas of revenue leakage and propose corrective actions
• Implement and maintain billing-related standard operating procedures (SOPs)
  
  

Claims Processing (60%)

• Verify and update insurance eligibility
• Communicate changes in eligibility to appropriate staff
• Contact providers for missing claims information
• Complete billing, reconciling, researching, and re-billing tasks including contacting insurance companies and working towards a resolution for payment
• Review insurance denials for patterns of denials and submit timely appeals and reconsiderations
• Proactively follow up on claims over 30 days outstanding
• Maintain claims over 60 days at less than 3% of total A/R
• Update billing systems with payment information and generate 2nd-payer claims
  
  

Staff Supervision (15%)

• Supervise Billing Team staff, including hiring and training, conducting annual performance appraisals, following policies and procedures, maintaining a healthy and safe working environment, and completing corrective actions including work plans and termination recommendations
• Assign and/or delegate tasks to Billing Specialists
  
  

Other Functions

Prepare checks for deposit

Other administrative duties as assigned

Knowledge And Abilities

• Knowledge of medical insurance claims billing, including Medicare and Medicaid
• Ability to communicate appropriately with staff and customers
• Ability to use professional judgement and make decisions based on information available
• Excellent organizational and time-management skills, including the ability to manage workflow and prioritize tasks to meet deadlines
• Knowledge of HIPAA confidentiality requirements as they relate to health care and personal health information
• Accurate data entry, including high attention to detail and the ability to self-monitor for errors
• Ability to concentrate on repetitive tasks and maintain attention to detail
• Ability to use a computer and e-mail for documentation and communication
• Ability to use standard office equipment and software programs
• Ability to work independently, including prioritizing tasks and monitoring errors
• Ability to remain in compliance with policies, procedures, regulations, and standards
• Ability to meet Universal Expectations of Employment
• Ability to perform physical requirements of the position, including lifting up to 25 pounds, standing, sitting, bending, kneeling, crouching, reaching, grasping, using fingers, speaking, repetitive motion, extensive use of computer
  
  

Requirements

3 years’ experience in medical claims billing, including payment analysis, research, denial resolution, and collections

Documentation of successful completion of a background and fingerprint check as specified by Oregon law, as well as a urinalysis drug screen

Preferred

• Experience with Medicaid/OHP benefits
• Experience in supervising staff or in a leadership role