Billing Specialist

Options Counseling and Family Services•Eugene, OR

11d•$17 - $24•Onsite

About The Position

The primary responsibilities of the Billing Specialist is the weekly billing of Oregon Health Plan (OHP) Medicaid Open Card or Coordinated Care Organization (CCO) and private insurance claims. This may include researching failed claims and denials, entering data into various accounting systems, and verifying eligibility and insurance authorizations. This role will regularly perform functions within the Options electronic client records (ECR), external systems and clearinghouses, and other internal accounting systems and software.

Requirements

Minimum of a high school education and one year of billing experience and/or equivalent combination of education and experience is required for this position.
Requires strong computer skills including proficiency with Excel and Word.
Must be a competent user of MS Excel and Word.
Commitment to Options’ core values of inclusion and respect, collaboration, transparency, outcome-based services, and flexibility.

Nice To Haves

Experience with an electronic medical record.
Experience in mental health and/or healthcare billing.

Responsibilities

Verify eligibility and obtain authorizations for new clients.
Obtain re-authorizations and close authorizations when needed.
Open new clients by verifying and entering payer information and authorization information in the electronic medical record.
Discharge clients in the ECR record and close authorizations when needed.
Work with relevant clinical staff & supervisors and ECR support team members on higher level ECR issues pertaining to billing/admin set up and logistics.
Troubleshoot and follow-up on various ECR issues pertaining to higher level failed claims.
Track claims flow – assure that claims are moving in a timely manner through the ECR and troubleshoot any issues.
Maintain and update payer plan fee matrixes as fee schedules are updated – troubleshoot the failed claims that arise from new fee schedules.
Coordinate with ECR support staff to assistant in completion of new contract set up in ECR – including (as needed), but not limited to: payer entry, payer plan fee matrix entry, procedure code entry, activity entry/creation, activity mapping, and program creation and linking/linkage.
May assist Quality Improvement (QI) Department on new provider set up and credentialing as it impacts billing.
Build claim batches and submit the OHP and DMAP billings electronically.
Perform accounts receivable processing in the electronic medical record.
Reconcile OHP Coordinated Care (CCO) and private insurance remittances.
Research payment differences.
Correct cash sheets for sliding scale and private pay.
Build claim batches for utilization data and submit monthly invoices with case rates for ICTS clients.
Bill private insurance payers and track deductibles and copays.
Reconcile remittances, research payment differences and make corrections on claims from remittances received.
Follow up collateral (secondary) authorizations and pending authorizations.
Bill private insurance, track deductibles and copays, and send out delinquency notices.
Research and correct failed claims and claim denials in the electronic medical record and PHTech claims system for different payers.
Prepare monthly billing statements or invoices for the Child Welfare, Self-Sufficiency, and System of Care contracts with the Oregon Department of Human Services (ODHS).
May be assigned other duties and projects, as needed.