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Great Lakes Bay Health Centers · 2 days ago

Billing Specialist

Saginaw, Michigan, United States

Full-time

Onsite

Entry, Mid, Senior Level

1+ years exp

Great Lakes Bay Health Centers is seeking a Billing Specialist responsible for the timely submission of claims, processing payments, and resolving billing issues. The role involves maintaining accounts receivable and providing customer service to patients and insurance carriers to ensure prompt payment for services rendered.

DentalHealth CareHospitalMedicalService Industry

Responsibilities

Ensure all claims are submitted for prompt payment. (20%)

Review, batch, and transmit/print claims/statements as assigned in a timely fashion

Work any rejected files/claims/statements at time of submission to ensure all claims sent were received at Clearinghouse and sent to insurances/patients

Maintain AR. (20%)

Monitor the assigned AR to ensure maintenance of a days in AR ratio of less than 90 while maintaining a standard gross collection ratio

Work collaboratively and proactively with insurance companies and patients to resolve issues that will lead to payment

Communicate to Manager any backlogged AR

Ensure credit balances are worked within 60 days

Process Payments and Rejections. (20%)

Process and post Credit Card, EOB and ERA payment files timely and accurately to ensure we balance deposits to postings for every batch

Coordinates with other billing staff to ensure all payments/deductibles/copays are posted monthly

Input CAS codes (including Rejection codes), date and COB information at time of posting and approve secondary claim to ensure claims are transmitted to Secondary Insurances the day after posting

Responsible for resolving rejected claim issues to ensure payment of claim. (20%)

Ensure all rejected claims are worked in timely fashion

Research rejections which include calling insurances to help understand what needs to be corrected and follow through on resubmission of claim based of insurance requirements

Communicate with Manager and staff on claim issues

Assists department maintaining patient accounts and providing customer service. (20%)

Answer telephone calls from patients and insurance carriers, providing complete and accurate information to resolve any claim related issue in effort to collect payment on services rendered

Initiate payment plans and review patient account in efforts to obtain payment and clean up all visits on the patient account

Verify all visits that are outstanding or have credit balance are worked correctly and resolved

Advise patients of balances that are past due, attempt to obtain payment/set up budget plans and coordinate Collection Agency balances as applicable

Handle any incoming mail as instructed by Manager

Act as assistant to other specified positions as assigned. Prepare applications and any other required paperwork in efforts to complete processing of requested documents in a timely manner

Acts as backup to other Specialists as directed by Manager

Qualification

Medical BillingEOB ProcessingClaims ResolutionCPT KnowledgeICD 10 KnowledgeMedicaid BillingMedicare BillingData Entry SkillsBilingual (English/Spanish)Organizational SkillsCommunication Skills

Required

High School Diploma

Coursework in Medical or Dental Billing OR Minimum of One (1) year of experience in Medical/Dental Billing including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files OR a combination of coursework and experience

High School Diploma

Associates degree in Medical or Dental Billing OR Minimum of two (2) years' required and 3 years' desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience. OR a combination of coursework and experience

Associate degree and/or Billing Certificates (CPC, RHIT, RCC)

Minimum of three (3) years required and 5 years' desired experience in Medical/Dental Billing, including: 1) processing and following through on Explanation of Benefits (EOB) and ERA files; 2) experience and understanding of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines; 3) experience working rejected and corrected claims, knowledge of payor guidelines and minimal resubmissions, handling appeals and understanding timely filing limits. Medicaid and Medicare billing experience

Level II (Senior Certified) – Certifications (CPC, RHIT, RCC

Knowledge of processing and following through on Explanation of Benefits (EOB) and ERA files including payments and Rejections

Knowledge of CPT, ICD 10, LCD's, NCD's and modifier use/guidelines. In depth knowledge of rejected claims and payor guidelines which includes minimal resubmissions, corrected claim submissions, appeals and understanding timely filing limits. Medicaid and Medicare billing experience is required

Strong data entry skills; ability to input a high-volume information accurately

Adept math skills with strong ability to perform reconciliation functions

Organized and detail oriented

Must have good computer skills, proficiency with Outlook, Word, and Excel

Proficient 10 key skills

Demonstrates strict adherence to HIPAA guidelines

Expertise in working rejections to resolve issues and obtain timely payment of claims independently

Ability to multi-task and provide a high level of productivity while maintaining accuracy

Must be able to work under pressure

Understand collection process

Desire to learn and master new things, seek help when needed and willingly assist others in time of need

Trainable and able to follow specific instructions