Job Description
Job DescriptionDescription:
JOB SUMMARY:
The Medical Billing Specialist will oversee and administer the insurance and billing processes for our clients receiving billable services (insurance/Medicaid) through Families in Transition’s clinical staff. The role is responsible for ensuring all participant insurance data is collected, claims are filed timely, and necessary action is taken to follow up on unpaid/denied claims. Utilizing monthly aging reports from the EHR, the Medical Billing Specialist is proactive in monitoring activity and systems to ensure submission and payments are accurate.
ESSENTIAL FUNCTIONS:
- Accurately prepare, review and submit clean claims to Medicaid/Insurance providers on the EHR to transfer to third –party payers, following up as necessary to obtain missing or incomplete information.
- Collect and record co-payments and any other payments from clients.
- Work directly with Medicaid/Insurance providers and clinical staff to ensure claims are processed and paid timely and accurately. Follow up as necessary on discrepancies.
- Post accurate insurance payments in accordance to Medicaid/Insurance Provider’s allowed reimbursement.
- Follow up with Medicaid/Insurance Provider on denied and unpaid claims. File, appeal, or re-bill as necessary with appropriate supporting documentation within standard billing timely filing limit.
- Monitor and utilize monthly aging accounts receivable reports to proactively follow up on unpaid claims aged over 30 days.
- Effectively communicate with clients and clinical staff to initially verify client’s eligibility and insurance, as well as the ongoing status of payments and eligibility as necessary if issues arise.
- Collect and enter all necessary client information including, demographic, guarantor, and insurance into EHR and other applicable systems as necessary.
- Oversee clinical staff and Program credentialing; track and take appropriate action to ensure agency staff and Programs remain accredited.
- Run month-end reports for Accounting, Program Managers, and senior management.
- Participate in in-service training.
- Attend all mandatory staff meetings.
- Perform other duties assigned.
Requirements:
MINIMUM REQUIREMENTS (Education/Experience/Certificates/Licenses):
· Bachelor’s Degree from accredited institution or Associate’s Degree and 3 years of experience.
· Proficiency with Microsoft Office products including Excel & Word.
· Computerized/electronic Accounting Software experience.
PREFERRED QUALIFICATIONS:
· Medical Billing certification preferred.