Program Billing Specialist (69441)

Essential Duties And Responsibilities

• Enters billing data from clinical documentation to generate accurate billing charges in accordance with funding source requirements.
• Reviews and verifies incoming clinical documentation for completeness, accuracy, and compliance with timeliness and payer-specific standards.
• Collaborates with manager/supervisor to ensure electronic billing charges and corrections are completed timely to support maximum reimbursement.
• Researches insurance claim denials, determines claim validity, and adjusts and resubmits claims through appropriate submission methods when warranted.
• Inputs and maintains billing-related data in billing systems in accordance with established procedures and controls.
• Maintains required performance data and billing and collections metrics.
• Safeguards eligibility and billing exceptions identified in the 271 eligibility file and 837 billing file are corrected and updated in the billing system in a timely manner; follows up with clinical staff to resolve data issues prior to the next billing cycle.
• Proactively identifies, prevents, and assists in correcting CDC errors in PICIS, and supports staff in determining CDC status and appropriate corrective actions.
• Proactively ensures all required eligibility information is obtained and updated timely to support accurate billing and maximum reimbursement; communicates barriers to timely and accurate billing to appropriate management.

Qualifications

• Education: High school diploma or equivalent required.
• Experience: Minimum of one (1) year of responsible administrative experience and knowledge Medicare and Medicaid billing required.
• Technical Skills: Proficient in Microsoft Office Suite or equivalent software. Intermediate computer skills.
• Communication & Interpersonal Skills: Excellent verbal and written communication skills. Strong interpersonal skills with the ability to work effectively with employees at all levels. Ability to collaborate professionally with diverse staff and stakeholders.