Billing Specialist

Region 8 Mental Health•Brandon, MS

45d

About The Position

BILLING DEPARTMENT SPECIALIST CHARACTERISTICS OF WORK Assist the Billing Department, Prior Authorization Coordinator, and agency by performing eligibility checks, prior authorization tasks, updating consumer billing records, and other duties as assigned by supervisors.

Requirements

1-2+ years related experience in healthcare claims and/or equivalent combination of education and experience
1-2+ years of experience with appeals and denials
Medical billing experience
General knowledge of claims forms and Explanation of Benefits forms
Experience with Electronic Medical Records
Knowledge of Medicare and Medicaid claims
Bachelor's Degree or High School Diploma or General Education Development equivalency and at least one (1) year work experience
Must have a valid Mississippi driver’s license and pass a criminal background check

Responsibilities

Maintain a high level of professionalism, conduct and appearance.
Utilize electronic portals to research and confirm insurance eligibility and update sliding fee scales and consumer billing records accordingly in the electronic health record.
Assist prior authorization team and program areas with confirming valid insurance and maintaining records.
Be proactive monitoring and correcting billing and eligibility data for all program areas as needed.
Become competent in Inovalon clearinghouse to manage claims as directed by supervisor.
Become competent in Carelogic EHR to manage claims, run reports and proactively improve revenue billing.
File Outpatient Treatment Requests and NOCs promptly and accurately.
Ensure claim and appeal timeframes are met.
Review electronic health records to correct failed claims, manage claims maintenance, and monitor and correct other relevant data to maximum billing/revenue while minimizing claim denials.
Educate and assist program area staff and front office staff with checking eligibility, sliding fee scale calculation, household income and size data, and authorization record keeping.
Ensure that Medicaid service limits are entered into electronic healthcare records to avoid staff providing excess service counts.
Understand and utilize payer contracts.
Follow up on all appeals, claims, letters, or other documentation with the insurer as needed.
Use available resources appropriately, including but not limited to training materials, shared drive, team meeting notes, etc.
Address all follow ups promptly according to priorities provided by leadership.
Follow all HIPAA guidelines in accordance with Employee Handbook.