Position Details

Billing Specialist

Reports to: Chief Financial Officer (CFO)

Pay Range: $26 to $31 per hour (DOE/DOQ)

Hours per Week: 40 hours

Workdays: Monday to Friday 8-5

Benefits:

  • Medical, Dental & Vision Insurance
  • Vacation, Sick Leave, Float Days & Paid Holidays
  • 403(b) Retirement Plan
  • Life Insurance
  • Long Term Disability
  • Wellness Program
  • Employee Assistance Program
  • LifeFlight Membership
  • Education Allowance

JOB PURPOSE:  The Billing Specialist is responsible for ensuring that all claims are processed timely and accurately, ensuring that all necessary procedures are completed prior to batch submission, denials and payments applied and/or addressed promptly, and that statements are finalized, in accordance with contracts.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Communicate professionally and directly with clients and staff regarding accounts.
  • Keeps electronic health record, payer records and fee matrixes updated, ensuring compliance with payer contract terms.
  • Verifies accuracy of billing data and corrects errors to ensure clean claims are produced.
  • Perform corrections of client information that includes, but is not limited to, demographics and insurance information.
  • Responsible for ensuring accurate and timely resolution of coding and billing issues.
  • Obtains and/or enters such documents as authorizations, financial agreements, and other such ancillary documents, as necessary.
  • Maintains detailed records and documents activities in client accounts when appropriate or as required.
  • Resolves discrepancies in client accounting records.
  • Interact with staff, clients, payers, and agencies to answer questions, obtain information, and resolve issues.
  • Monitors aging reports and take such steps as necessary to guarantee timely payment of claims.
  • Coordinates and collects necessary information from staff, clients, or payers for claim adjudication.
  • Participates in take-back, overpayment, and refund process.
  • Recognizes problem accounts and notifies appropriate staff or supervisors to assist in problem resolution.
  • Assists in the creation of manuals and protocols.
  • Participates in the training of new staff members.
  • Maintains familiarity with and handles client information in accordance with Federal Regulations (42 CFR, Part 2), the Revised Code of Washington (RCW 71.05.390 and RCW 71.24), and other applicable laws pertaining to confidentiality of client and staff information.

SECONDARY DUTIES AND RESPONSIBILITIES:

  • Keep abreast of changes in financial software and government reporting regulations related to medical claims submission.
  • Maintains physical security of confidential materials and assigned Agency property.

PERFORMANCE EXPECTATIONS:

  • This position requires strong working knowledge of managed care plans, insurance carriers, referrals, and pre-certification procedures.
  • Strong working knowledge of CPT, ICD-9, ICD-10, HCPCS, modifiers, coding, and documentation guidelines.
  • Strong customer service, organizational and communication skills are essential to this position.
  • This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment.
  • General computer skills, typing skills and a working knowledge of Medicare Compliance.

REQUIRED EDUCATION, LICENSE(S), CERTIFICATION, AND EXPERIENCE:

Education: Minimum High School Diploma or GED

Experience:   

  • Two years of experience in claims billing using a centralized billing system or clearinghouse.
  • Experience in healthcare billing.

Additional requirements:

  • Must be able to pass a pre-employment drug test and background check
  • Must be able to provide vaccination records for MMR, Hep B, Tdap and recent flu shot

PREFERRED ADDITIONAL CREDENTIALS / EXPERIENCE:

Education:  Associate or Bachelor's Degree

Experience:   Medical coding 

Licensure:  Certified Professional Coder

KNOWLEDGE, SKILLS, AND ABILITIES:

Essential:

  • Experience with ICD-10, CPT, and medical terminology preferred.
  • Must be proficient in Excel, Word, and ten-key by touch.
  • Experience with Qualifacts CareLogic or similar EHR system.
  • Excellent verbal and written communication skills.
  • Excellent customer service skills.
  • Must be able to resolve client billing problems in a timely manner.
  • Must have the ability to add, subtract, multiply, and divide in all units of measure using whole numbers, common fractions, and decimals.

NATURE AND SCOPE:

Physical Demands:

  • Moderate physical effort (up to 10 lbs.).
  • Occasional standing/walking.
  • Prolonged sitting at desk/computer.

Cognitive Skills:

  • Analytical skills.
  • Attention to detail.
  • Strong interpersonal skills.

Working Environment:

  • May be exposed to infections and contagious diseases.
  • Occasionally exposed to clients exhibiting assaultive behaviors.

Working Demands:

  • Frequent pressure due to schedule demands.
  • Contact with clients under a wide variety of circumstances.
  • Subject to varying and unpredictable situations.
  • Participates in private audits and government audits periodically.

Principal Challenges:

  • Keeping all billing compliance rules updated and relating changes to clinical teams.


*Peninsula Behavioral Health does not discriminate because of a person's presence of any sensory, mental, or physical disability, race, creed, color, national origin, sex, sexual orientation, gender identity including transgender status, marital status, pregnancy, childbirth, and pregnancy-related conditions, age (40), honorably discharged veteran or military status, or use of a trained dog guide or service animal by a person with a disability, state employee or health care whistleblower status.