Responsible for updating staff on billing policy and procedure regarding compliance with federal and state rules, regulations and standards. Monitors company compliance with above. Provides compliance and oversight to managed care programs and clinical information systems.
The Billing Specialist is a key position in the Revenue Cycle and manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, and insurance inquiries/correspondence. The Billing Specialist will assist in the clarification and development of process improvements and inquiries, ensure payments related to client services from all sources are recorded and reconciled accurately and timely into the Electronic Medical Record.
- Accurately processes Medicaid/Private Insurance billing daily.
- Verifies completeness and accuracy of all claims prior to submission.
- Updates staff regarding updates on insurance billing policy and procedures to ensure compliance with appropriate laws, rules, regulations and standards.
- Oversees updates and trains staff regarding clinical information systems.
- Monitors co-pays compliance with approved laws, regulations and standards. (i.e. HIPAA, Medicare, Medicaid, etc.)
- Researches and resolves issues with billable Medicaid/Private Insurance services.
- Assure coding is compliant and up to date.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Other duties as assigned.
- At least 3 - 5 years’ experience in a mental health setting dealing with billing standards and MIS.
- Experience working with medical payers including Medicare, Medicaid, and commercial insurance.
- Working knowledge of medical billing systems, particularly Credible.
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