What are the responsibilities and job description for the Human Services Billing Specialist position at Ozaukee County?
Job Summary:
The DHS Billing Specialist performs functions required to process health insurance claims, monthly client statements and maintain accounts receivable for services provided in the Human Services Department, relating to Outpatient Behavioral Health programs, Birth-To-Three program, and Room & Board/Residential Treatment/Inpatient Hospital. The DHS Billing Specialist works with clients to set up payment plans when necessary, and monitors compliance with payment plans that are in place. The DHS Billing Specialist works with the DHS Billing Coordinator, the Office Services Manager and reception staff to recoup funds through the Sate Debt Collection program when other options are exhausted. This is a non-exempt position.
Essential Functions and Responsibilities:
The following duties are primarily performed and are essential for this position. Employees are expected to be able to perform each of these job duties satisfactorily and successfully with or without reasonable accommodations to be qualified for the position. Other duties may be required and assigned.
50% Accounts Receivable Management:
Trains reception staff on Insurance Eligibility processes.
Monitor reception staff for fiscal compliance when obtaining up-to-date insurance, demographics, appropriate financial documentation and general client file maintenance.
Minimum Education Qualifications:
Education and/or Experience Requirements:
Associate’s degree or certification in Medical Billing/Coding.
High School Diploma.
Three to five years’ healthcare billing experience.
Experience in mental health and substance abuse billing preferred.
Licenses, Certifications and Other Requirements:
None
Minimum Knowledge, Skills and Abilities Qualifications:
In order to perform the functions and responsibilities of the position (listed above) the following knowledge, skills, and abilities are essential.
Physical Requirements:
Inside office work in a professional office setting.
Shared work environment
EOE/ADA Statement:
Ozaukee County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, Ozaukee County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.
Nothing in this job description limits management’s right to assign or reassign duties and responsibilities to this job at any time. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. The job description does not constitute an employment agreement or affect the at-will nature of the employment arrangement between the employee and company and is subject to change by the employer as the needs of the employer and requirements of the job change.
The DHS Billing Specialist performs functions required to process health insurance claims, monthly client statements and maintain accounts receivable for services provided in the Human Services Department, relating to Outpatient Behavioral Health programs, Birth-To-Three program, and Room & Board/Residential Treatment/Inpatient Hospital. The DHS Billing Specialist works with clients to set up payment plans when necessary, and monitors compliance with payment plans that are in place. The DHS Billing Specialist works with the DHS Billing Coordinator, the Office Services Manager and reception staff to recoup funds through the Sate Debt Collection program when other options are exhausted. This is a non-exempt position.
Essential Functions and Responsibilities:
The following duties are primarily performed and are essential for this position. Employees are expected to be able to perform each of these job duties satisfactorily and successfully with or without reasonable accommodations to be qualified for the position. Other duties may be required and assigned.
50% Accounts Receivable Management:
- Records client and Third-Party payments in the electronic health record (EHR) database.
- Reviews insurance payments entered in the EHR database by other DHS staff for accurate payment application.
- Reviews insurance payments imported from clearinghouse – reviews each client on remittances and initials corrections if necessary.
- Identify deductibles/coinsurance/copayments, roll-down balance to next payer or client.
- Investigate and resolve denied claims using clearinghouse, contacting the payer, or by making corrections through the clearinghouse or insurance company’s web portal using the knowledge of DHS and insurance company/government regulations.
- Reviews unapplied payments made by insurance companies and clients determine if a refund is due.
- Follows-up on outstanding insurance invoices by coordinating with insurance companies.
- Prepares collection forms for past due client balances according to county ordinance and give to program manager for approval. Work with staff to ensure collection referral warning letters are sent, and that collections are entered into the State Debt Collection system if no action is taken by the client.
- Verifies and reviews eligibility for new IBHS, Crisis, CSP, CCS clients by coordinating with insurance companies.
- Adds payer(s) to client record if needed and update activities that may have been entered prior to plan entry and verification.
- Maintains accuracy of existing client data, including payer information, demographics and financial data.
- Generate and review patient statements based on the needs of the program, ensure statements are delivered to clients.
- Determine account status by verifying previous statement action.
- Identify overdue balances that may need to be referred to the state collections department for collection.
- Determines Self-Funded crisis activities (for previous year) and review for Medicaid eligibility. Adds payer and updates all activities for eligible date range.
- Enters authorizations in EHR database, for Birth-to-Three Monthly Cost Share (MCS), Children’s Long-Term Support Waiver Annual Parental Fee (PPL)
- Responds to questions concerning client statements, coordinate review and discussion with case manager.
- Explains financial liability for services to client or responsible party through a trauma informed lens.
- Informs clients of their payment options.
- Sets up and maintains Monthly Payment Plans for clients.
- Works with DHS Billing Coordinator for any updates to insurance billing policies, requirements.
- Assists DHS Billing Coordinator in maintaining and updating payer contracts for agency and individual provider data.
- Assists DHS Billing Coordinator with revalidating Medicaid enrollment for DHS Programs via ForwardHealth Portal.
- Assists DHS Billing Coordinator with credentialing existing providers for new payers.
- Assists DHS Billing Coordinator with credentialing new providers for payers.
- Assists DHS Billing Coordinator in maintain spreadsheet for all credentialing information.
- Obtains current county malpractice insurance to use for credentialing and recredentialing with payers each year.
- Attends quarterly Wisconsin Regional Billing Specialists in-person or virtually.
- Assists in client billing and distributes funds to Representative Payee clients when Office Services Supervisor is out of the office.
- Assists in the insurance claim filing, insurance authorizations when DHS Billing Coordinator is out of the office.
Trains reception staff on Insurance Eligibility processes.
Monitor reception staff for fiscal compliance when obtaining up-to-date insurance, demographics, appropriate financial documentation and general client file maintenance.
Minimum Education Qualifications:
Education and/or Experience Requirements:
Associate’s degree or certification in Medical Billing/Coding.
High School Diploma.
Three to five years’ healthcare billing experience.
Experience in mental health and substance abuse billing preferred.
Licenses, Certifications and Other Requirements:
None
Minimum Knowledge, Skills and Abilities Qualifications:
In order to perform the functions and responsibilities of the position (listed above) the following knowledge, skills, and abilities are essential.
- Excellent verbal interaction and written communication with clients, insurance companies, and co-workers.
- Understanding of CPT coding
- Understanding of fiscal and confidentiality requirements in Human Services Programs.
- Understanding of HIPAA compliance.
- Proficient in data entry and use of office, accounting and billing software.
- Intermediate to advanced knowledge of Microsoft Word and Excel
- Ability to understand medical/health insurance billing requirements.
Physical Requirements:
- Prolonged Periods of sitting and working on a computer.
- Periodic periods of standing or walking.
Inside office work in a professional office setting.
Shared work environment
EOE/ADA Statement:
Ozaukee County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, Ozaukee County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.
Nothing in this job description limits management’s right to assign or reassign duties and responsibilities to this job at any time. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. The job description does not constitute an employment agreement or affect the at-will nature of the employment arrangement between the employee and company and is subject to change by the employer as the needs of the employer and requirements of the job change.
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