Billing Specialist

About the role

This position is responsible for managing and resolving insurance denials from Medicaid, Medicare, commercial, and managed care payers. Duties include submission of electronic claims, payment posting, review and resolution of error reports, and the correction, appeal, and rebilling of outstanding insurance receivables. The role also involves verifying and obtaining insurance authorizations as required, accurately entering and maintaining patient demographic and billing information, and utilizing EHR reporting to identify and correct service issues that impact billing. Additional responsibilities include management of the billing hotline and client statements, as well as appropriate adjustment of client account ledgers.

Job Duties

• Submit, track, and reconcile electronic insurance claims
• Post insurance payments and contractual adjustments accurately and timely
• Review remittance advice and resolve payment discrepancies
• Identify, correct, appeal, and rebill denied or unpaid claims for Medicaid, Medicare, commercial, and managed care payers
• Verify insurance coverage and obtain required authorizations in accordance with payer requirements
• Maintain accurate patient demographic, insurance, and billing information within the EHR
• Utilize EHR and financial reports to identify and resolve documentation or service issues that impede billing
• Coordinate with clinical and administrative staff to ensure billing accuracy and compliance
• Assist the billing phone line and respond to client billing inquiries professionally and in a timely manner
• Prepare and distribute client billing statements
• Perform client account and ledger adjustments in accordance with organizational policy and payer guidelines
• Ensure compliance with all applicable regulatory, payer, and confidentiality requirements
• Other duties as assigned

Minimum Qualifications

• A minimum of one year of outpatient medical revenue cycle experience is required, with preference given to candidates with behavioral health experience
• Medical Billing, HIM, and/or Coding Certification is required
• Must possess Knowledge of ICD-10CM, CPT and HCPCS
• Prefer experience in Behavioral Health Billing

Education & Experience

• Bachelors degree preferred
• One year of experience working Medicare, Medicaid and third party outpatient insurance claims and denials utilizing an EHR; or in lieu a two year degree in Medical Billing, HIM, or a Billing/Coding certification required

Additional Requirements

• Must be 21 years of age
• Negative Drug Screening prior to hire and throughout employment
• Clear Criminal Background Check throughout employment with Suncoast Center and local checks prior to hire and annually along with DCF Level II prior to hire and as required by DCF
• Must have valid Florida Driver's License, Motor Vehicle checks prior to hire and annually with acceptable driving record maintained throughout employment along with reliable vehicle, valid registration, and valid vehicle insurance
• Must be in compliance with Florida Laws and Administrative Codes with fingerprinting and determined to be of good moral character
• Must be computer literate including Excel spreadsheets, electronic claims processing with 837 and 835 files, website portal navigation, EHR comprehension, Microsoft Outlook
• Netsmart AVATAR experience a plus

Core Competencies

• The ability to function and operate as a team player, showing dignity and respect for all
• The ability to comply with all equal employment opportunity and ethical standards and regulations
• The ability to take direction in a respectful and productive manner from supervisors and managers
• The ability to work, as scheduled, in a timely fashion, and with an attitude oriented to service
• The ability to have cordial and professional relationships both within the organization and with vendors, clients and third parties
• If appropriate, the ability to produce all appropriate paperwork and reports consistent with contractual, state or federal standard, and to prepare and submit such paperwork on a timely basis
• The ability to understand and comply with Suncoast Center, Inc. policies and procedures
• The ability to render compassionate care and equal commitment to serve clients in need of healthcare assistance

Working Conditions

Work schedule may vary according to department demands. Work is performed indoors.

Benefits & Perks

Health & Wellness

• Medical, dental, and vision insurance with 0 copy for Teledoc Appointments
• EAP Supports
• Company Paid Basic Life, Accidental Death and Dismemberment, and Long term Disability
• Options to secure additional Life/AD&D as well as short term disability

Work-Life Balance

• Paid time off + 10 company paid holidays

Growth & Development

• Professional development options through our Learning Management System and live trainings

Other Perks

• 403b with up to a 5% company match
• Monthly Social Committee Events

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