Billing Specialist

TITLE: Billing Specialist

RESPONSIBLE TO: Billing Manager

WORK AREA: Remote WV/OH

SUMMARY: The Billing Specialist plays a pivotal role at Path Behavioral Healthcare. As a Biller, you'll ensure timely and accurate billing operations, helping families navigate their healthcare finances with ease. Our aim? To create a transparent and efficient billing system, reinforcing our commitment to the community and promoting trust, clarity, and peace of mind.

BLOODBORNE PATHOGEN CATEGORY I: Tasks with actual blood/body fluid exposure are not included in this position’s duties as the job requires therapeutic counseling only.

DUTIES AND RESPONSIBILITIES

General Responsibilities

· Review patient bills for accuracy and completeness and obtain any missing information.

· Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.

· Assist with payroll close bi-weekly as needed

• Assist with daily Failed Activities and Failed Claims as needed

· Follow up on unpaid claims within the standard billing cycle time frame.

· Call insurance companies regarding any discrepancy in payments if necessary, Identifying and billing secondary or tertiary insurances.

· Review accounts for insurance of patient follow-up. Researching and appealing denied claims.

· Submit claims to the clearinghouse (Medicaid and Medicaid Managed Care), fix rejections as needed.

· Work on denied claim(s) and rebill when necessary.

· Uphold strict adherence to HIPAA guidelines, confidentiality protocols, billing and coding standards, and company policies.

· Respect and uphold cultural diversity, religious, and personal values of clients and their families in alignment with the agency's mission.

· Exhibit a positive professional demeanor and serve as an exemplary representative of Path Behavioral Healthcare's mission and vision.

· Collaborate effectively with all Path Behavioral Healthcare employees, demonstrating a clear understanding and adherence to organizational processes and policies.

· Take on additional tasks or responsibilities as assigned by the Operations Team and Billing Manager.

QUALIFICATIONS

Education

Candidate must have a high school diploma or GED.

Experience

A minimum of two years of experience in a medical office setting and at least one year in medical billing and billing software. Strong familiarity with Medicaid and insurance web portals and knowledge of the life cycle of claims.

Physical Effort: This position requires the ability to work under stressful conditions and to work irregular hours. Requires sitting for extended periods of time, viewing computer monitors, and keyboarding.

Communication Skills: Must have excellent verbal and written communication skills to communicate professionally via telephone and in writing. Strong grammar and writing skills are crucial for clear and concise communication with clients, colleagues, and other healthcare professionals.

Interpersonal Skills: The successful candidate must demonstrate the ability to interact and assist in a friendly, compassionate, and professional manner with colleagues, providers, clients, and their families, as they represent both themselves and Path Behavioral Healthcare.

Essential Technical/Motor Skills: Candidates must achieve competency in the Electronic Health Record (EHR) program, telemedicine services, and any added software programs used by the company, ensuring efficient access, and updating of client information. The role requires fine dexterity, adept handling, and proficient gripping abilities to perform various tasks.

Background: The candidate must pass all federal and state background checks, and their educational and work history will be confirmed in compliance with company policies.