Billing Specialist

About the role

Maintains client accounts, submits claims to insurance companies and Medicaid, and generates client invoices.

Responsibilities

• Verifies individual client’s private insurance and Medicaid for Admissions in order to provide parents/guardians with payment estimates prior to scheduling appointments.
• Completes prior authorization requests for private insurance clients and maintains them, as required.
• Uses private insurance and Medicaid verifications to set up all payor sources in applicable billing system to ensure that billing is submitted to the correct primary, secondary, and tertiary payor sources.
• Updates and maintains client information upon notification of changes.
• If there are changes to individual accounts which affect ACCESS’s ability to bill for services, notify Accounts Receivable Supervisor immediately.
• Sets billing on hold for clients that are determined to be ineligible.
• Contacts parents regarding status of Medicaid and monitors status.
• Keeps Accounts Receivable Supervisor apprised of status.
• Processes medical records requests from insurance companies.
• Works partial payments and denials in both systems.
• Collaborates with Clinical Services Coordinator (CSC) to determine status of therapy prior authorizations.
• Researches classroom, therapy, and AERC denials and partial payments.
• Works with Waiver Department to obtain needed prior authorizations or to work through problems.
• Recommends and submits write-offs to Accounts Receivable Supervisor for review and approval.
• Prints, reviews, and mails monthly statements.
• Discusses any accounts with larger than typical or questionable balances with Accounts Receivable Supervisor prior to mailing.
• Filings and maintains paperwork related to billing records, including insurance Explanations of Benefits (EOB), Remittance Advices (RA), etc.
• Completes relevant and approved in-service trainings.
• May perform other related and non-related duties, as assigned.

  Competencies

  • Treats people with respect.
  • Inspires the trust of others.
  • Completes work ethically and with integrity.
  • Upholds organizational values.
  • Follows instructions and responds appropriately to supervisory direction and feedback.
  • Follows through on commitments.
  • Completes tasks within established timeframes or notifies appropriate person with an alternate plan.
  • Focuses on solving conflict instead of blaming.
  • Maintains confidentiality.
  • L-listens to others without interrupting.
  • Keeps emotions under control.
  • Remains open to others’ ideas and displays willingness to try new things.
  • Communicates with others in a tactful and professional manner.
  • Responds well under pressure.
  • Treats others with respect and consideration, regardless of their status or position.
  • Identifies and resolves problems in a timely manner.
  • Gathers and analyzes information skillfully.
  • Develops alternative solutions.
  • Works well in group problem-solving situations.
  • Uses reason, even when dealing with emotional topics.
  • Prioritizes and plans work activities.
  • Uses time effectively and efficiently.
  • Plans for additional resources.
  • Develops realistic action plans.
  • Demonstrates accuracy and thoroughness.
  • Looks for ways to improve and promote quality.
  • Applies feedback to improve performance.
  • Maintains own work to ensure quality.
  • Balances team and individual responsibilities.
  • Exhibits objectivity and openness to others’ views.
  • Gives and welcomes feedback.
  • Contributes to building a positive team spirit.
  • Supports everyone’s efforts to succeed.

    Physical Demands

    • Sit frequently.
    • Use hands to finger, handle, or feel.
    • Reach with hands and arms.
    • Occasionally lift and/or move up to 50 pounds.
    • Use close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
    • Work in a moderate noise environment.