Job Description

Position Primary Purpose:

The Revenue Cycle Billing Specialist is responsible for comprehensive insurance billing and tracking grant fund allocations to client accounts. Collaborating with the Revenue Accounting Manager, this role also oversees self-paying client accounts. This position demands exceptional attention to detail, strong organizational and communication skills, and the ability to work both independently and collaboratively to meet multiple deadlines effectively. This position will work closely with our Medical, Dental, and Behavioral Health Program Managers.

Essential Functions:

Ensure completeness and accuracy of insurance claim information, including patient details, insurance ID, diagnosis and treatment codes, and provider information. Submit insurance claims electronically to clearing houses or individual insurance companies. Prepare and submit secondary claims for patients with multiple insurers upon processing by the primary insurer. Address patient inquiries regarding copays, deductibles, write-offs, and other patient-responsible portions, resolving complaints and explaining non-covered services. Follow up on unpaid or rejected claims with insurance companies, resolving issues and re-submitting claims as necessary. Post insurance and patient payments using claim billing software. Handle patient information in compliance with HIPAA guidelines. Create insurance or patient aging reports periodically to identify unpaid claims or patient accounts. Understand managed care authorizations and coverage limits, including visit numbers and dollar amounts associated with insurance coverage. Verify patient benefits eligibility and coverage. Look up ICD-10 diagnoses, CPT and HCPCS treatment codes using online services or traditional coding references. Assist in provider credentialing. All other duties and responsibilities as assigned.

Key Competencies:

Demonstrates good judgment and discretion in handling sensitive information. Maintains confidentiality and protects patient information in compliance with HIPAA guidelines. Possesses excellent telephone and client relations skills. Highly detail-oriented with strong organizational skills. Open to cross-training in other office functions to enhance operational efficiency. Able to accept and provide constructive feedback positively. Exhibits a professional demeanor with a sense of humor. Demonstrates leadership capacity and the ability to work both independently and as part of a team. Practices effective self-care and stress management techniques. Strong problem-solving skills and the ability to resolve billing and insurance issues promptly. Proficient in using billing software and familiar with ICD-10, CPTHCPCS coding. Effective communication skills, both written and verbal, with patients, team members, and insurance companies.

Minimum Requirements and Education:

High school diploma or equivalent required, associate degree or higher in a related field preferred. Minimum two (2) years of experience in full cycle billing, rules and compliance in a health care setting. Demonstrated accuracy and attention to detail in all work areas, including typing, data entry, managing deadlines, report generation, and insurance communication. Proficient in Microsoft Excel, including the use of functions and report design. Strong understanding of HIPAA guidelines and confidentiality practices. In-depth knowledge of insurance billing and reimbursement processes. Strong computer skills with the ability to quickly learn new software. Effective communication skills for interacting with insurance agencies both over the phone and in person.

Preferred Requirements:

Experience working in CareLogic, eClinicalWorks, and Open Dental. Certificate or associate degree in medical billing/coding.
Strong understanding of insurance plans (Medicare, Medicaid, Commercial) and FQHC Billing.

Compensation: Salary is DOE, starting at $23 per hour