Billing Specialist

Position Summary: This position is responsible for prioritizing and batching material for data entry which requires knowledge of technical material. Must be capable of high-volume data entry. The Billing Specialist will review, post, and submit claims that are compiled on a daily basis through the Practice Management System. This position will also be responsible for statement processing and posting payments and adjustments to patient accounts and assisting with Sliding Fee Scale applications and audit processes.

Supervision Received: Billing Manager

Supervision Exercised: N/A

Position Responsibilities: The following information is intended to be representative of the essential functions performed by incumbents in this position and is not all-inclusive.

1. Process insurance claims to various types of insurances and self-pay patients
2. Research and communicate with insurances and third parties regarding claim denials, making corrections as needed.
3. Verifies patient eligibility and obtains referrals necessary for billing as needed.
4. Reconcile lab vendor charges and correct discrepancies.
5. Make necessary billing/coding corrections and refile denied claims for reprocessing.
6. Process and post patient payments in a timely manner. Process refunds/adjustments as needed.
7. Answer patient inquiries regarding account status, as well as communicate with third party payors and other authorized personnel providing billing and patient account information.
8. Identify, research and resolve patient billing issues.
9. Review and research bad address files.
10. Assist with provider insurance credentialing duties as needed.
11. Assist with Sliding Fee Scale application and audit processes.
12. Educate self on practices of payors, federally qualified health centers, and others as necessary.
13. Responsible for calling patients to collect on outstanding balances and attempt to set up payment plans. If unsuccessful, then responsible for turning over to collections agency and reconciling collection accounts.
14. Assist NHC personnel when needed as time permits.
15. Assist with reports to maintain federal funding as requested.
16. Assist with updating policies, procedures, and forms as needed.
17. Participate is staff meetings and other meetings as instructed.
18. Maintain confidentiality within the workplace and within the community.
19. Handle protected health information in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
20. Adhere to the Mission and Values of NHC.
21. May be asked to perform other duties that align with NHC’s mission, including but not limited to participation on clinical committees, providing education, Quality Review and/or other activities.

Billing Specialist Position Requirements:

1. Excellent communication skills.
2. Attention to detail.
3. Computer knowledge.
4. Medical Terminology.
5. Experience in coding and charge entry.

Minimum Requirements:

1. Ability to perform each position responsibility satisfactorily with or without reasonable accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties of the position.
2. Ability to understand that safety is a condition of employment. Unsafe acts or conditions will be reported to the supervisor.
3. Must be able to read, write and speak English.

Education and/or Experience:

1. High School diploma or equivalent

License and/or Certification:

1. Valid North Dakota Driver’s License
2. Current Immunization Records
3. Current PPD

Special Requirements:

1. Northland Health Centers has a Drug-Free Workplace Policy, employees are subject to random drug screens and periodic background checks.
2. Influenza vaccination is a condition of employment.

Appearance Standards: This position shall follow the appearance standards as outlined in the NHC Personnel Appearance Policy.