Billing & Operations Specialist - Mental Heal

At Wellpoint Care Network, our mission is to facilitate equity, learning, healing, and wellness by restoring the connections that help children and families thrive.

Every person deserves the opportunity to reach their fullest potential. It’s part of human nature, and the promise of our country, that everyone be given a fair chance to be and do their best. Yet, many in our community live with unresolved childhood and generational trauma.  

That’s where we come in. We believe we can create a world where children and families have a clearer path to their fullest potential. Wellpoint Care Network has championed the restoration of families for nearly 175 years.

Job Purpose: 

Our next Billing and Operations Specialist - Mental Health will be responsible for supporting day-to-day operations, collaborating with internal teams, and providing superior client care via the outpatient mental health clinic’s front desk. The position works closely with the Revenue Cycle Senior leader to ensure accurate and timely billing. 

Qualifications: 

• HS diploma or equivalent required; bachelor’s degree preferred.
• A minimum of five (5) years of healthcare billing experience in an electronic health record (EHR) system use required.
• A minimum of five (5) years of customer service experience is required.
• Experience working with clients/patients in a healthcare setting required; Behavioral Health preferred. 
• Experience performing clinic operational tasks such as creating and organizing workflows, monitoring clinic staff coverage, billing functions, etc. required.   
• Knowledge of medical billing procedures, terminology, and coding systems (ICD-10, CPT, HCPCS)
• Knowledge of Medicaid, Medicare, commercial health plans and benefit verification. 
• Knowledge of healthcare regulations and guidelines. 
• Understand and be able to convey to clients their insurance benefits: copay, coinsurance, deductible, Prior Authorizations, etc.
• Ability to analyze billing data to identify trends and potential issues.
• Ability and comfortability managing individuals in crisis, screening for level of need, utilizing de-escalation and following procedures to notify management team.
• Ability to use and maintain various types of office equipment including phones, computer software/hardware, fax and eFax, scanner and copying machines.
• Ability to function independently and in a team while being supportive of the organization’s mission and goals.
• Strong communication skills both verbal and written including good spelling, punctuation, and sentence structure.
• Strong attention to detail and accuracy.
• Proficient in the usage of computer software; demonstrate an understanding of computer file systems and computer software packages, e.g., Adobe Pro DC, Microsoft Office, Excel, Outlook, Teams, OneNote, etc. 
• Must be honest, dependable, and able to meet deadlines.
• Physical exam, drug screen, motor vehicle report, and background checks are required for this position.
• A valid Wisconsin Driver’s License or occupational driver’s license, Not required but must have reliable transportation to be onsite for position.

Duties:

Billing Coordination

• Coordinates and supports billing workflow activities including tracking client data, scheduling, billing, and completing insurance verification.
• Verifies client benefits and eligibility.
• Processes insurance and client payments. 
• Responds to external billing related inquiries and serving as an internal resource for patient billing questions and concerns. 
• Addresses and resolves customer inquiries with billing disputes. 
• Reviews and supports the correction of claim and clinician service errors.
• Monitors account statuses and balances, identifying and resolving inconsistencies. 
• Processes records requests according to policy.
• Prepares monthly and ad-hoc reports as requested. 
• Performs daily, weekly, and monthly balancing functions. 
• Supports Revenue Cycle Senior Leader with month-end reporting. 
• Audits data for upgrades and issues in EHR.

Clinic Operations

• Monitors clinic operations to ensure efficiency and effectiveness in assigned areas of work identifying opportunities for improvement and suggesting solutions. 
• Work in tandem with intake staff to provide coverage and arrange coverage. 
• Conducts schedule prep process for all patients to ensure all paperwork and documentation is complete, active insurance/payment method is on file, and demographics are accurate.
• Identifies, reports, and resolves problems regarding registration and insurance involving appropriate individuals and departments as required.
• Completes tracking protocols according to procedure for follow up needs (record requests, treatment plan signatures, miscellaneous inquiries etc.).
• Reviews appropriateness for additional screening forms (PHQ9) and provide to clients at time of intake. 
• Ensures data integrity, maintain adequate documentation for grant reporting, and job duty analysis. 
• Performs general office duties to ensure office is running smoothly such as scanning documents, sending e-faxes, managing shared office email, ordering supplies, and managing general office upkeep.
• Maintains confidentiality and adheres to all HIPPA requirements.

Client Service Coordination

• Explains outstanding balances and payment obligations to clients at the time of their service, collects and posts payments.
• Ensures phone calls are answered timely to ensure excellent customer service.
• Responds to urgent in-person and phone requests, screening for suicidality, and triaging patient needs appropriately. 
• Addresses crisis situations utilizing de-escalation, and trauma informed care techniques, and navigating individuals through the appropriate crisis intervention protocol.   
• Provides support to patients with requests via phone, email, and portal with payment/billing related questions, scheduling needs, release requests, miscellaneous inquires, etc.
• Supports patients with telehealth access, Patient Portal issues, and other technology-related troubleshooting as needed.

Program Coordination

•  Provides general clinician support by assisting clinicians with administrative questions and/or duties such as sending letters, faxes, etc.
• Coordinates with clinicians pertaining to any additional patient questions.
• Supports clinician schedules by auditing for appointment accuracy.
• Communicates with peers, staff, and others in a manner that supports patient care and creates a welcoming and safe environment for individuals seeking service. 
• Acts as a liaison between Wellpoint Care programs by facilitating completion of paperwork, following up on internal referrals, and being a primary contact point for CFWB and CCS families.
• Works in partnership with the Campus Service Manager and Guest Service Representatives:  
  1. Coordinating with the GSRs on client transportation needs.
  2. Responding to questions about clinic appointments.
  3. Redirecting phone calls/messages as needed.
  4. Being the contact person when a clinician is unavailable
  5. Providing the daily clinic schedule.

Agency Engagement 

• All employees will be evaluated on their demonstration of consistent commitment to the Agency’s Seven Essential Ingredients, Diversity, Equity and Inclusion, and engagement in the strategic initiatives of the organization. This will be measured by their active participation in committees and workgroups, and by their communication and practice within their daily work and in the community.
• Participates in assigned meetings, events and learning as required.
• Other duties as assigned including serving in a coverage role for other department members.
• Serves as an active, participating member of the Safety Committee representing the Mental Health group.

Position Details & Extras:

• Full time.
• Onsite / Hybrid work is available with reliable broadband connection.
• Fast-paced setting, many interruptions with some projects with quick deadlines.
• Moderate exposure to noise.
• Must be able to perform the following functions: read, write, lift, walk, stand, sit, reach over shoulder and head, push and pull, repetitive bending and stooping, repetitive finger and wrist motion, repetitive use of arms, and ability to respond to telephones and other auditory stimulation.
• Subject to frequent interruptions with ability to manage multiple tasks simultaneously.
• Demonstrates an understanding of the cultural differences among diverse groups and the need to adapt service provision to match these differences in respectful ways.
•  Public Service Loan Forgiveness (PSLF) - Wellpoint employees may be eligible for loan forgiveness under the Public Service Loan Forgiveness program. 
• De-escalation of dysregulated visitors utilizing trauma informed principles.
• Involved with personnel, residents, family members, visitors, volunteers, interns, and vendors under all conditions and circumstances.
• Incumbents will occasionally need to be available for overtime and/or provide flexibility during office hours to accommodate special events, peak demand, or staff shortages.

Organizational Information: 

At Wellpoint Care Network, we have seen exactly how trauma, poverty, systemic racism, social injustices, and other barriers create instability in all areas of life. The people in our care face education and health disparities, high unemployment rates and unaffordable housing. What’s worse, many have lost connections to resources, family, friends, and other support systems. We have seen the toll it has on a person’s physical, emotional, and financial well-being to try and successfully navigate complex systems that may have failed them in the past.

We believe there is a better way. So, we have anchored ourselves in our 170 years of caring for our neighbors through modernized human services.

Wellpoint Care Network provides a rich continuum of services, including:

•        Child Welfare and Foster Care 

•        Support for youth who have aged out of care

•        Care Coordination and Wraparound services 

•        Mental health therapy and supports such as our Clinic, Family Preservation, Caregiver Support, and Integrated Community Treatment

•        Professional education and clinical consultation (for organizations, schools, and individual/family) 

Wellpoint Care also works to promote a diverse and caregiving environment to ensure that those we serve and employ are valued, accepted, respected, and treated equitably.

•        Equity means we work tirelessly toward fair and just treatment, systems, and policies. At Wellpoint Care Network, we believe that we are accountable – individually and collectively – when inequity or injustice replaces equity and inclusion. 

•        Inclusivity means that we consciously build groups that welcome and celebrate differences in age, race, ethnicity, class, gender, sexual orientation, religion, gender expression, education, socio-economic background, personal history, geographical location, marital status, parental status, and work experiences.   

Interested parties please apply online. We are committed to enhancing diversity, equity and inclusion and strongly encourage minority candidates to apply. For more information, visit our website www.wellpointcare.org.

Equal Opportunity Employer