Medical Billing Specialist

REPORTS TO: Office Lead
CLASSIFICATION: Non-Exempt
FUNCTION: Performs Accounts Receivable Operations

ESSENTIAL JOB FUNCTIONS

Clerical & Administrative Duties

• Answer incoming calls and distribute messages promptly.
• Call families for appointment reminders, missed therapies, therapist cancellations, and other notifications.
• Distribute mail and type correspondence as needed.
• Record minutes for staff meetings.
• Check in patients and collect/post patient payments; document on cash sheet.
• Accept, document, and process requests for records per authorization and privacy guidelines.
• Comply with all facility policies, HIPAA, and regulatory requirements.

Patient Intake & Documentation

• Receive and document referrals; process new referrals daily.
• Enter demographic and insurance information into EMR.
• Add new referrals and plan of care.
• Upload intake paperwork.
• Ensure parents complete online paperwork, medical history, updates, etc.
• Annually update contact information and authorization for release of information.

Scheduling & Coordination

• Manage waiting list and schedule new patients for evaluations and ongoing treatments.
• Track family requests for schedule changes.
• Annually repopulate schedule in EMR.
• Run daily Medicaid eligibility checks.

POC Tracking

• Ensure progress notes and re-evaluations are completed timely; obtain physician signatures on POC every 3 months.
• Track that documents are signed daily.
• Fax POCs for physician signature; monitor and refax as needed.
• Monitor plan of care for each patient.

Billing & Financial Responsibilities

• Establish and maintain accurate payor files; verify eligibility and benefits prior to first appointment.
• Secure authorizations as required.
• Post charges and payments to patient accounts.
• Prepare, review, and transmit claims (electronic and paper); follow up on unpaid claims, denials, and appeals within timely filing limits.
• Review remittance advice/EOBs for accuracy and finalize claims.
• Generate patient statements monthly; review accounts for accuracy and completeness.
• Refer delinquent accounts to Office Lead.
• Generate month-end billing reports.
• Establish & maintain accurate payor files on all patients

• Check eligibility and benefits verification prior to child’s first appointment

• Enter insurance detail in patient chart and ensure payor records are kept up to date

• Secure authorizations as required

Reporting & Compliance

• Report claims, receivables, and delinquent accounts monthly.
• Monitor and report changes affecting verification, pre-certifications, claims processing, and collection procedures as needed.
• Track changes in fee schedules or covered services from payors/regulators.
• Monitor authorization requirements, contractual rate changes, and denial trends.
• Comply with the Facility’s Comprehensive Compliance Plan (CCP) and all local, state, and federal regulations.

Comply with the Facility’s Comprehensive Compliance Plan (CCP)

This includes but is not limited to: Business & Clinical Operations, Environmental Health & Safety, HIPAA, Human Resources and Code of Conduct as well as all facility policies and procedures and educational requirements associated with the CCP.

Comply with all local, state and federal regulations training and instruction requirements as well as any other standards that govern healthcare services provision.

POSITION REQUIREMENTS:

• Attention to detail-mathematical and data processing

• Data processing proficiency—Billing & practice management systems and Excel

• Communication skills—written, verbal and general interactive

• Organizational skills—priority setting, file maintenance & report generation

EDUCATION:

• High school or equivalent skills & aptitude; prefer business school graduate

• Basic computer courses or equivalent preparation

EXPERIENCE:

• Medical A/R management

• Insurance industry claims processing/management

PHYSICAL DEMAND CAPACITY:

Consistent with published industry PDC norms or minimally:

• Sitting-routinely for 1-2 hours uninterrupted

• Lifting-occasionally light loads (5-10 pounds)

• Bending & reaching—routinely for office duties

• Walking—routinely to access other personnel

• Viewing monitor screen/using keyboard—routinely >1 hour duration

EXPOSURE DETERMINATION:

• Has the potential for Hazardous Substance Exposure due to work duties

• Has no potential for Bloodborne Pathogen Exposure due to work duties

HIPAA STATUS:

Has been determined as eligible for access to/use of PHI & EPHI based on work duties and responsibilities in compliance with ‘minimal necessary’ standards

Joe’s Kids has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the team member’s ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by management staff as deemed appropriate. This document does not represent a contract of employment and Joe’s Kids reserves the right to change this job description and/or assign tasks as needed.