Address
Form of workPOSITION TITLE: Billing Specialist
WORKSITE LOCATION: GBC Regional Plaza, 6502 Nursery Drive, Suite 100, Victoria TX 77904
PAY: Starting at $15/ hour EEOC CODE:Admin Support Workers FLSA STATUS: Non-Exempt
EDUCATION AND EXPERIENCE REQUIRED: Required: High School Diploma or GED equivalent
SHIFT: Fulltime; Monday thru Friday, 8:00am - 5:00pm, some on-call shifts evenings or weekends
ESSENTIAL FUNCTIONS and DUTIES:
1.Processes Billing of Behavioral Health and Primary Care services to Customers and Third-Party Payors.
2.In EHR maintains posting of all payments, makes necessary contractual adjustments, and transfers customer responsibility.
3.Maintains all related files to include scanning and downloading for Explanation of Benefits.
4.Verifies insurance eligibility for denied claims.
5.Research unapplied customer payments and determines which service payments should be posted to.
6.Process Payor and customer refunds for overpaid services.
7.Work directly with Financial Analyst to recover missing general ledger payments.
8.Reviews, analysis, and research Clearinghouse transactions for rejected claims, appropriate authorizations, and uploads for all Mental Health (MH) Provider and Intellectual Developmental Disabilities (IDD) Authority Services with Texas Medicaid and all other Payers.
9.Coordinate, research, and resolve complex issues with MH and IDD Management for rejected claims.
10.Maintains denial log, prepares appeals, and investigates all denied claims.
11.Maintains processes of re-billing of rejected and denied claims.
12.Prepares and reports denial information for CFO's Monthly & Annual Billing Report.
13.Work Directive Payment Program (DPP) Report and submit to Revenue Manager & CFO.
14.Prepares and reviews monthly reports for program & payor combination to adhere to billing rules for maximum billing opportunities.
15.Reviews the services monthly 'Show' report, coordinates with clinical staff for errors and omissions, and finalizes processes needed to complete the claims.
16.Collects outstanding accounts receivable balances for insurance follow-up.
17.Knowledgeable of Payor timely filing deadlines.
18.Access Payor websites to determine the reason claims are unpaid. If the issue is more complex, call Customer Service. If the claim issue is unresolved contact provider services for resolution.
19. Update corrected claims for place of service, modifiers and taxonomy codes and resubmit to Clearinghouse for reprocessing and updated the status to be "corrected claims" with the original claim number.
20.Retrieve explanation of benefits for non-payment reason codes.
21.Request medical records and submit to Payors if they need additional information to expedite a claim.
22.Appeal denied claims.
23.Document insurance status under RWQM in the EHR System.
24.In EHR System maintenance of Payor Plans, retrieve insurance ID cards from Medical records Department, some cases involve additional research because of missing information.
25.Set-up co-pays in EHR System.
26.Retro Payor Plans to Medicaid start date if the Payor backdates the eligibility for new members. This process will allow us to maximize billing and Payor reimbursement capturing the past ninety-five (95) days of service which was initially categorized as general revenue.
27.Work billing warning errors associated with Payor Plan information which could be electronic Payor ID, contact information, Social Security Numbers and Date of Birth.
28.Eligibility verification of 270/271 Report to identify Payor Plan changes.
29.Daily provider schedules, ensuring the eligibility and Payor Plans are updated for TRR Services the financial assessments are completed, Commercial Program services customer co-pays, co-insurance, deductibles self-pay rates and MAPs are collected. Discuss larger balances with customers by telephone or in person, accept payments and make payment arrangements. Deals with difficult customers.
30.Maintain time sensitive CAQH documents and perform attestation and maintain files.
31.Identifying discrepancies in information and conducting follow-ups.
32.Assisting providers with credentialing inquiries.
33.Responding to health plan provider inquiries.
34.Capturing primary source documentation in computer databases.
35.Ensuring data is backed up and maintains a current hardcopy and electronic vendor credentialing files.
36.Serve as a backup to team members explaining customer shares.
37. Attends monthly Information Systems (IS) Department meetings to troubleshoot identified claims billing issues.
38.Attends Managed Care organization monthly meetings with Billing Team to discuss credentialing, reimbursement, or denial issues.
39.Assist Revenue Manager with incoming provider applications, Standard Credentialing Form, NPI Form, creating a new application or link an existing one to our Center, Child Abuse Background Check Form 1600 and Payor access forms signed and dated.
40.Assist Revenue Manager with set-up of a new CAQH account for new providers or link to their established file.
41.Assist Revenue Manager with screening practitioners' applications and supporting documentation to ascertain their eligibility.
42.Assist Revenue Manager with collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
43.Assist Revenue Manager with base credentialing for CMS Medicare and Texas Medicaid & HealthCare Partnership. Upon completion of the base credentialing, then extends the credentialing process for Managed Care Organizations and Commercial Payors on-line or submit a Roster. Track provider participation levels.
44.Assist Revenue Manager with initial credentialing and re-credentialing applications.
45.Maintain confidentiality in compliance with federal HIPAA Regulations.
46.Ensuring compliance with applicable laws, regulations, procedures, and policies.
47.Provide patients with proper education when necessary regarding patient balance.
48.Understand trauma informed services.
ESSENTIAL FUNCTIONS AND DUTIES:
1. Understands trauma-informed services.
2. Understands the Three E's of trauma-informed care.
3. Understands the Four R's of trauma-informed care.
4. Understands the six key principles of trauma-informed care.
PHYSICAL REQUIREMENTS and ENVIRONMENTAL CHECKLIST: Abilities required to perform the essential and marginal tasks of this job. Walking, Operating office equipment, Standing, Light lifting, under 15 lbs., Sitting, Ability to see, Identify colors, Light carrying, under 15lbs., Hearing (with aid), Straight pulling, Ability to write, Ability to count, Ability to read, Simple grasping, Ability to tell time, Travel by car 5% of time, Inside, Working closely with others, and working alone
CRED/PRIV REQUIRED? No DRIVING REQUIRED: No
OTHER REQUIREMENTS OR CONDITIONS (specify):
1. Current State of Texas Driver License or if you live in another state, must be currently licensed in that state. Liability insurance required.
2. Must be insurable by Center's liability carrier if employee operates a Center vehicle or drives personal car on Center business.
3. Good driving record as defined by Gulf Bend Center.
4. Must complete all CORE training requirements prior to the due date.
5. Must have computer experience to include Microsoft Word, Excel, and Outlook. Must have good organizational skills to achieve multiple deadlines. Ability to type 40 wpm.
6. Must maintain regular attendance and reliability which is critical to business operations. This is a fulltime position. Days and hours of work are Monday through Friday, 8:00am to 5:00pm or agreed upon hours 100% of the time, to ensure consistency and completeness of program's processes. Evening and weekend work may be required as job duties demand.
AAP/EEO STATEMENT:
Gulf Bend Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identify or expression, or any other characteristic protected by federal, state, or local laws.
This policy applied to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
