Billing and Claims Specialist

Lumibility•Westbrook, CT

4d•$24 - $26•Hybrid

About The Position

Assist in the overall daily office and administrative activities to support the Children & Family Services division of Lumibility.

Requirements

High school diploma/GED required
Proficiency in Microsoft Office software including Word, Outlook, and Excel
Must possess a valid Connecticut driver’s license, have an acceptable driving history and be able to utilize your own vehicle for Lumibility business as defined by Lumibility’s policy
Experience with medical billing, insurance reimbursement and reconciliation, preferably in a clinical/medical environment required
ICD/10 and CPT coding experience required
Knowledge of insurance/Medicaid practices required
Ability to recognize discrepancies in billing data and investigate the issue to determine resolution
Excellent interpersonal skills and phone interactions
Must have strong organizational skills and the ability to work in a fast-paced environment
Must have internet access, a cell phone, private workspace, and reliable transportation
Knowledge of medical billing and insurance reimbursement
Skill in data entry, analyzing information, documentation and reporting
Skill in planning, organizing, attention to detail and work in a fast-paced environment
Skill in problem solving and decision making
Skill in operating standard office equipment, computer and various software packages
Skill in communicating effectively in a courteous and professional manner
Skill in writing clearly and concisely to maintain accurate records
Ability to read and understand policies and regulations and to translate general guidelines into specific action
Possess critical thinking skills
Ability to demonstrate good communication and interpersonal skills necessary to provide guidance and instruction to families
Ability to work successfully, both independently and in a team environment
Ability to maintain confidentiality
Ability to maintain a patient and positive attitude
Ability to drive/travel to varying locations as needed
Ability to identify and prioritize daily tasks depending on timelines related to daily workflow
Skill in planning, implementation, self-monitoring and organization
Skill in effective problem-solving and decision making
Ability to stay current with changing technology trends
Ability to work flexible hours and travel as needed

Nice To Haves

Bachelor’s degree in related field preferred
Bilingual (Spanish) preferred
Knowledge of medical coding preferred

Responsibilities

Input employee and independent contractor billing information into state database accurately and expeditiously to ensure proper records handling and prompt payment responses
Initiate internal billing corrections and voids process according to procedure and make corrections in agency and state database
Run reconciliation reports to identify data and billing errors, adjudication reports and follow up to make corrections
Enter client data from eligibility documents including insurance forms and statements of eligibility into state database
Review and identify errors proactively and take necessary action to track and resolve
Work collaboratively with the state contacted billing company, opening tickets, investigating and working claims, adjudication, denials, appeals and reimbursement
Update job knowledge by participating in training opportunities and keeping current on state contract, insurance billing and reimbursement procedures. Adhere to company standards and federal and state requirements
Maintains communication with other departments to promote positive working relationships and open communication
Develop processes to address systems (embed resources and procedure changes into office procedures, create a day-to-day task priority list, determine needed changes to current procedures, create checklists for checks and balances and revise as needed)
Verify insurance information in state and private insurance company database
Enter insurance information in state database
Participate in state led Community of Practice meetings and subcommittees, work collaboratively with Business Operations Manager to generate and maintain procedures related to the Billing & Claims position
Perform other roles within the office team to provide support as requested
Contribute during meetings and training sessions
Performs other duties as assigned.
If bilingual, provides interpretation for families during phone conversations and verifies translated documents as needed.