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Job Summary: Billing Specialist is responsible for scrubbing and processing billing claims for all Health Services claims—including Medical, Dental, and Behavioral Health—addressing claim denials, and posting payments all within in a timely manner.
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Essential Duties and Responsibilities
Charge Capture:
- Review and process pending charges from the EHR into the Practice Management (PM) system
- High level chart review and resolution of any billing encounters based on EHR documentation
Claims Processing:
- Bill Encounters
- Review claim production status report daily
- Address all claim edits and resolve any issues to ensure an accurate claim is produced and all claims have a clean status
- Generate Electronic Data Interface (EDI) Files
Claims Submission and Response Review:
- Generate EDI claim batches and submit the files through the clearinghouses
- Monitor claims generated and submitted by the billing department routinely and remediate discrepancies
- Download vendor rejection files, generate reports, address adverse results, and document follow-up activities
- Communicate to Front Desk Manager(s) at Health Services to address any outstanding issues
System:
- Access the following systems daily to complete Biller tasks and responsibilities:
- eCW (Electronic Health Records System)
- Third Party Administrators (TPAs) / Payer Portals/Clearinghouses
Administration:
- Provide claim data tracking & reporting to the Billing Supervisor and Accounting Manager – Revenue & Billing, as requested.
- Assist in gathering requested supporting documentation for the annual audit and tri-annual HRSA audits.
- Additional duties as assigned by the Billing Supervisor.
Minimum Qualifications
- High school diploma or GED, or equivalent experience in health care billing (2 years)
- At least three (3) years experience in health care billing
- Excellent phone etiquette
- Attention to detail
- Intermediate Microsoft Excel experience, including general navigation, reading/interpreting data, and creating charts and pivot tables
What Qualifications or Experience You May Bring:
- Bachelor’s degree
- Experience with eClinicalWorks (eCW), an Electronic Health Records (EHR)/Practice Management (PM) System
- Experience with dental billing
- Hold current medical billing and coding certification from the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA)
- Knowledge of federally qualified health center (FQHC) revenue cycle management processes
- Advanced Excel skills and strong proficiency in other Microsoft Office applications
PHYSICAL REQUIREMENTS
Ability to move to or remain sedentary for periods of time in various locations
Project HOME provides equal employment opportunities to all employees and applicants for employment, without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws. Project HOME prohibits discrimination and harassment of any type.
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