Billing Specialist I

Spectrum Health & Human Services

Agency Profile: Spectrum Health & Human Services respectfully partners with adults, children, and families as they recover from behavioral, emotional, mental health and/or substance related disorders by offering individualized and meaningful opportunities of hope, empowerment and support to achieve self-defined improvements in their quality of life.

Full-Time 227 Thorn Ave, Orchard Park NY

SUMMARY OF POSITION FUNCTION:

Responsible for organizing, coordinating and monitoring billing related functions as assigned by and under the direction of the Accounts Receivable Manager. Coordination of communications between team members as well as internal and external vendors. Maintenance of client accounts and payer related activity in the electronic health record system.

MAJOR DUTIES AND RESPONSIBILITIES: 

• Performs authorization verification functions; obtains required information and addresses problems
• Works with site office staff to ensure that all insurance information, procedures and policies are current and adhered to
• Enters all financial related information into the electronic health record system within a 48 hour period verifying accuracy
• Verification of demographic information for accuracy
• Assures appropriate clinical staff are assigned based on insurance restrictions, notifying site Directors of potential case transfers
• Verifies and enters Insurance and private fee data including authorizations if required
• Attests that all regulatory policies and procedures are adhered to based on current guidelines. 
• Tracks and verifies new client financial data is received at administration within 48 hours of assessment visit
• Works with site office staff to correct information deficiencies and address problems
• Monitors all fee for service billing to ensure regulatory compliance and adherence to agency submission timeframes
• Processes claims on a minimum of a bi-weekly basis generating claim batches. Basic level and low volume of claims.
• Accurately edits claims for successful submission and payment
• Submits 837 files and verifies 277 acceptance of file uploads
• Reviews all pended and denied claims for resubmission or insurance representative follow-up. Basic level and low volume of claims.
• Processes all private fee monthly statements, no later than 1 workday after Fiscal Closing, work schedule must accommodate this process.
• Is responsible for reporting inaccuracies related to coding, pricing, authorizations, etc to the Accounts Receivable Manager for programming into the Cerner software
• Adheres to Code of Ethics; reports all concerns and violations to management staff and/or Compliance Officer
• Operates office machines and instructs others in the operation of same
• Ability to work on site as required by departmental policies 
• Other duties as assigned

 SKILLS/COMPETENCIES:

• Excellent interpersonal skills and communication skills both verbal and written
• Requires organizational skill and ability to make contacts and establish relationships to obtain information necessary for the program to functions within the larger system
• Meticulous documentation/recording skills and attention to detail; excellent time management and organizational skills
• Ability to handle multiple tasks
• Proficient in the use of computer software such as MSWord, Excel, Power Point, Outlook, etc. 
• Ability to operate office equipment

EDUCATION REQUIREMENTS:

• High School Diploma or equivalent

EXPERIENCE:

• One years’ work-related experience, preferred
• Must possess a valid Driver’s License with an acceptable driving record