24-10 Claims/Billing Specialist (Union)

Position: Claims and Billing Specialist (Union) 

Position code: 24-10

Position Location: Administrative Building

Current Work hours: 40HRS/WK

Compensation Range: $18.00/HR-$22.67/HR

          If Annualized: $37,440.00-$47,153.60

Position Dates: ASAP

Supervisor: Susan Baranski, Admin Supervisor-Finance

Date Position Posted: 12/21/2023

Internal Deadline: 12/29/2023

Requirements: Bachelor's degree in a related field from four-year College or University preferred. 

Testing Requirements: Critical Thinking Assessment

All internal and external job applicants are required to use UltiPro to apply for this position.  Please see the Sanilac County CMH website at www.sanilaccmh.org and click on “Employment”.

JOB DESCRIPTION

Job Title:                         Claims & Billing Specialist

Department:                   Finance

Location:                        CMH Administrative Building

Supervisor:                     Admin. Supervisor – Finance/Billing

Shift:                              M–F, 40 hour week

Classification:                 6 (Six)

Prepared Date:                8/28/2023

HR Reviewed:                      8/28/2023, 12/21/2023.

Prepared By:                    CFO, Admin. Supervisor – Finance/Billing

Reviewed By Supervisor: 8/28/2023, 12/21/2023.

Revised Date:                      12/21/2023

SUMMARY

Under the direction of the Admin. Supervisor – Finance/Billing, and in conjunction with the other Billing and Finance staff, completes duties as assigned in the areas of claims processing, billing and reimbursement.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Process all assigned Provider Network claims through the computer system’s claim adjudication process within the appropriate guidelines of the Agency and PIHP.  Send claim rejections to appropriate providers and follow-up as needed. Ensure that Medicaid is payer of last resort. Submit invoices to the Finance staff as appropriate.
• Communicate and work effectively with Provider Network staff as necessary to facilitate prompt payment. Monitor the timeliness of Provider Network claims payment from receipt to payment. Assist with training to Provider Network staff regarding claim entry into OASIS. Assistance to Provider Network staff regarding claim entry into OASIS.
• Complete Financial Determinations at intake and annually for all non-Medicaid individuals. Track/monitor ability to pay information for all non-Medicaid individuals. Keep current and up to date on MDHHS ability-to-pay rules.
• Generate appropriate billing for all assigned 3rd party payers, secondary payers and COFR payers for all services, voiding and correcting errors, address and reprocessing rejections, and verifying waterfall through appropriate guidelines of insurance payers.  Ensure that Medicaid is payer of last resort.  Correspond with staff as necessary on issues arising from payer’s rules/regulations.
• Enter/process all assigned 3rd party insurance payments for services provided, no matter the form of the remittance; to appropriate individual accounts in the Agency’s electronic medical record (OASIS). Reprocess/address all assigned 3rd party payer rejections and rebill all assigned 3rd party payers as appropriate and in a timely manner. Generate Open-Line-Item reports monthly for all assigned 3rd party payers and address all services from prior billing months appropriately to ensure that all (open) services have been rebilled appropriately within a timely period. Keep reconciled monthly Open-Line-Item reports on file for all 3rd party payers.
• Process all claims through the computer system’s claim adjudication process within the appropriate guidelines of the Agency and PIHP.  Send claim rejections to appropriate staff and follow-up as needed. Submit invoices to the Finance staff as appropriate.
• Review Medicaid, Medicare, BCBS, and MI Child Bulletins/updates. Knowledge of MDHHS and Medicaid Standards. Maintain integrity and confidentiality of client records and personal health information.
• Complete monthly, quarterly, and annual reports for the CFO and/or Admin. Supervisor – Finance/Billing.
• Attend MARO and other trainings as appropriate.
• Assist with eligibility and authorization requests as needed.
• Assist with Finance/Billing projects.
• Stay current with and adheres to Agency policies and procedures.
• Stay current with and follows Agency trainings and procedures.
• Perform other duties as assigned.

COMPETENCIES FOR ADMINISTRATIVE STAFF

Sanilac CMH staff are dedicated to providing services to the community to improve lives.  When they see a task that needs to be completed, they step in to assist or are first in line to help the Agency in promoting recovery, discovery, and independence.  Each staff member works within their strengths and collaborates with their coworkers so that collectively we are a stronger whole.  Staff provide positive feedback and suggestions to improve the quality of care in the Agency.  They hold their coworkers, the individuals they serve and the community in high esteem.

To perform the job successfully, an individual should demonstrate the following competencies:

Initiative/Organization/Reasoning:

• Takes initiative and steps in to take on difficult challenges.
• Willing to identify problems and work to resolve them in the early stages.
• Plans and organizes work activities and uses time efficiently.
• Properly organizes and carries out job tasks in a timely manner.
• Is a self-starter in attaining job objectives.
• Know and understands job expectations and is willing to expand job knowledge and skills to be more effective to the Agency and the individuals served.
• Is enthusiastic about the Agency’s Mission and is a positive influence for co-workers and individuals served.
• Demonstrates an understanding of and adherence to Agency policies and procedures and is willing to provide suggestions to make policies and procedures more efficient.
• Is willing to think outside of the box while able to make sound decisions and taking actions based on sound reasoning and weighing possible outcomes.

Ethics/Teamwork:

• Consistently treats all people with dignity and respect.
• Demonstrates expected ethics and principals.
• Accepts responsibility for actions and follows through on commitments.
• Demonstrates ability and willingness to work cooperatively and effectively as part of a team.
• Willingly acknowledges team members and co-workers’ value to your work.

Emotional Intelligence:

• Verbal and written communication is constructive, effective, respectful, and clear.
• Demonstrates the ability to adapt to changes in work situations.
• Willing to take the time to learn about co-workers’ personality so that working together is more effective.
• Willingness to ask questions, listen to others’ ideas, and understand how the impact of your work, impacts your co-workers/team.
• Establishes and maintains effective relationships.
• Willing/Ability to be cost conscious
• Staff are expected to learn and understand job functions and carryout tasks in a proficient manner.

SUPERVISORY RESPONSIBILITY

This job has no supervisory responsibilities.

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

Bachelor's degree in a related field from four-year College or University preferred. Associate’s degree or equivalent from a two year college or technical school in a medical billing/claim adjudication field; or 5 years of experience or training in third party insurance billing/claims adjudication process. Two or more years working in an EMR system preferred.  

COMPUTER SKILLS

Working knowledge and experience of the Microsoft environment (i.e. Outlook, Word, Access and Excel).  Typing speed of 45 wpm is recommended.

LANGUAGE SKILLS

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions one on one, from groups of managers, clients, customers and the general public.

MATHEMATICAL SKILLS

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.  Has the ability to apply concepts of basic algebra and geometry.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES, LICENSE, REGISTRATIONS

Valid Michigan Driver’s License

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and talk or hear.  The employee is occasionally required to stand; use hands to finger, handle or feel objects, tools or controls and reach with hands and arms.

The employee must occasionally lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Sanilac County CMH embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence.  An employee in this or any position is expected to support the employment environment.  This includes having lived experience with behavioral health issues.

Sanilac County CMH embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence.  An employee in this or any position is expected to support the employment environment.  This includes having lived experience with behavioral health issues.

Welcome to Sanilac County Community Mental Health

AFSCME Employees

In your orientation, you will find several benefits.  You may want to take a moment to review the benefits listed below and costs associated with each of them. You must work over 30 hours per week to be eligible for medical and café benefits. Paid time off accruals are based on hours worked.

Benefit

Plan

Eligibility

Contributions per Month

Medical Insurance

POS $1,000/$2,000- 20%

BCN POS

Annual Deductibles-

In Network-

Individual-$1,000/Family- $2,000

First of month following hire date.

$35.95 - Single

$74.29 - Two Person

$99.88 - Family

Medical Insurance

BCN HMO $2,000/$4,000

BCN HMO HDHP

H.S.A. Eligible Plan

Annual Deductibles-

Single-$2,000/Family- $4,000

First of month following hire date.

$42.80- Single

$88.60 - Two Person

$118.58 -Family

Medical/Rx Alternate

HMO HSA $3200/$6400

*Exchange State Bank-H.S.A Host

BCN HMO HDHP

H.S.A. Eligible Plan

Annual Deductibles-

In Network-

Single-$3,200/Family-$6,400

First of month following hire date.

$0.00 - Single

$0.00 - Two Person

$0.00 - Family

Annuity/Decline Medical Plans

Nationwide 457b

Eligible if waived all medical plans

$233/Month (less Social Security & Medicare taxes)

Dental Insurance

BCBSM

Annual Max-$1,500 per member

Orthodontics-$1,500-lifetime

First of month following hire date.

$44.45- Single

$88.90 - Two Person

$155.57 – Family

Vision Insurance

Nation Vision Administrators

-NVA

First of month following hire date.

$10.54-Single

$18.94-Employee+ Spouse

$16.84-Employee+ Child(ren)

$27.38-Family

AFLAC

Multiple plans available for review for employee only and for family members

First of month following hire date.

Costs vary depending on plans purchased.

Deferred Compensation

Nationwide-457B

*same account as your retirement contributions.

Prior to the first of each month.

Set up your own account or $233 (pretax) from medical opt out option

Life Insurance

 RELIANCE- $20,000 Policy Automatically if Union member.

*Can purchase additional Personal and Depen...