MaineCare Billing Specialist

Qualifications

• One year experience in health care billing. Experience in the mental and behavioral health care industry preferred
• Experience with computerized billing systems, spreadsheets and word processing programs
• Strong oral and written communication skills

Certifications

• Valid CHRC - Maine DOE Background Check
• Go to https://www.maine.gov/doe/cert/fingerprinting for instructions on how to create an MEIS account
• Register at https://me.ibtfingerprint.com/ to make your fingerprints appointment. ($55 fee)
• Submit a new application for CHRC. ($15 fee)

• Check Acentra and HealthPas (MIHMS) daily for new Prior Authorizations and/or Continued Stay Reviews. Record new authorizations in Therap.
• Monitor authorization dates to minimize lapses in payment.
• •  Communicate with staff re: upcoming due dates for timely submission.
• Check Unposted Sessions Summary Report (Acuity) monthly and contact providers who are behind in posting and missing student information (ex. ICD-10 codes).
• Provide monthly Provider reports to administration with provider activity information (Hours/sessions/unposted).
• Review non-billable & missing information reports from EDMS and communicate to providers items to correct for OT, PT and ST.
• Monitor Authorization and ITP/ISP expiration dates, communicate with Clinicians to be sure there is not a lapse in billing eligibility.
• Understand, manage, and coach providers in the use of Electronic Health Records.
• Communicate with EDMS and Therap to solve any difficulties staff may have.
• Distribute instruction material, organize training, etc. as needed.
• Provide EDMS with rate sheets for OT, PT and SL.
• Collect and file signed Statement of Reassignment forms.
• Collect signatures and file signed Electronic Signature Verification forms.
• Assist staff with registration for BHP training. Collect and file BHP certificates and service provider licenses.
• Collect and record Parental Consent for MaineCare Billing.
• Monitor Student MaineCare eligibility.
• Communicate with staff to ensure all Sessions/ISP Data are completed in a timely manner so billing can occur.
• Submit claims (837 transactions) to MIHMS weekly.
• Post MaineCare payments (835 transactions) received to Therap.
• Send monthly reimbursement reports to the Finance manager.
• Research/resubmit denied and/or suspended claims.
• Update Therap by adding/discharging students and staff.
• Review SEED Payment Report quarterly through NEO.
• Maintain Provider information in the MIHMS portal.
• Update rates and modifiers as needed.
• Add new staff accounts to Therap and Acentra.
• Check monthly for late documentation and send claims.
• Maintain strict confidentiality.

• 260 days (Fulltime - Year Round)
• 30 hours/week, additional hours may be available
• Earned vacation and sick time

• Travel between schools or district buildings may be required for certain positions

Reports To: Director of Special Services or their designee

Terms of Employment:  This is an at will positions not governed by a collective barging unit & employment is determined annually by the District.

Evaluation: Completed annually by Director or their designee.