Medical Billing Specialist

Full-Time/Hourly

$20.00 - $25.00/Hour (based on experience)

Team Recovery Ohio, LLC, the fastest-growing organization providing treatment for substance use and mental health disorders in Northwest Ohio, is seeking a Full-Time Prior Authorization Billing Specialist! Qualified applicants must be motivated, compassionate, and energetic, with the ability to adapt and problem-solve potential issues.

The RCM Specialist is responsible for managing the pre-authorization, credentialing, and billing processes to ensure the timely submission of claims to insurance companies and accurate reimbursement for healthcare services provided.

Job Functions/Duties:

The essential functions include, but are not limited to the following:

• Coordinate and manage the pre-authorization process for medical procedures and treatments, ensuring all necessary information and documentation is obtained from healthcare providers and patients.
• Review and verify insurance eligibility and coverage, ensuring proper pre-authorization requirements are met.
• Ensure accurate and complete documentation is submitted for pre-authorization, including medical records, diagnostic tests, and supporting documentation as required.
• Stay abreast of insurance guidelines, policies, and procedures, ensuring compliance while advocating for the best interest of patients and the organization.
• Monitor and track pre-authorization requests, follow up on pending approvals, and escalate any issues or delays to appropriate stakeholders.
• Maintain organized and up-to-date records of pre-authorization activities, including approvals, denials, and any additional required documentation.
• Collaborate with healthcare providers and insurance companies to resolve pre-authorization-related inquiries, disputes, and appeals in a timely manner.
• Conduct periodic audits of pre-authorization processes to identify areas of improvement and implement efficient workflows.
• Coordinate and manage all aspects of the credentialing process, including gathering necessary documentation, completing applications, and submitting them to insurance companies and other relevant organizations.
• Monitor the status of credentialing applications and communicate updates to healthcare providers and management as needed.
• Maintain accurate provider credentialing records, ensuring all necessary documentation is collected and stored in accordance with regulatory requirements.
• Review and resolve billing issues, including claim denials, rejections, and appeals.

Skills and Knowledge:

• Strong knowledge of Medical Billing and coding procedures, including insurance guidelines and pre-authorization requirements.
• Familiar with medical terminology and procedures, as well as an understanding of different insurance plans and coverage types.
• Must pay exceptional attention to detail and strong organizational skills.
• Excellent written and verbal communication skills, with the ability to collaborate effectively with healthcare providers, insurance companies, and patients.
• Must be able to work independently, and possess excellent time management skills with the ability to multitask, prioritize, meet deadlines, and communicate challenges effectively.
• Proficient in problem-solving and critical-thinking skills, with the ability to effectively navigate complex pre-authorization processes with real time solutions.
• Possess strong ethical standards, and the commitment and ability to apply discretion with confidential patient material and situations.
• Must be proficient in using electronic medical records (EMR) systems, billing software, and insurance portals.
• Working knowledge of Microsoft Office Suite (Word, Excel, Powerpoint, OneNote, Calendar, Outlook, and Teams).
• Working knowledge of Google Workplace (Docs, Sheets, Slides, Forms, Gmail, Chat, Spaces, Keep, Tasks, Calendar, and Meet).
• In-depth knowledge of Credentialing systems and procedures, including MITS, PNM, and more.
• In-depth knowledge of Medical Billing and Coding systems and procedures, including CPT, ICD-10, HCPCS coding, and more.
• Knowledge of submitting and following up on Prior-Authorizations.
• Proficiency with insurance guidelines, including Medicaid and private insurance carriers.
• Understanding of HIPAA regulations and ability to maintain confidentiality of patient information.

Requirements:

• Valid Driver's License and insurance with clean driving record.
• Ability to pass a background check and pre-employment drug screen.
• Minimum of 3+ years of billing experience and a strong understanding of the credentialing, prior authorization, and insurance reimbursement processes.
• Experience in the Behavioral Health and SUD treatment field.

Education:

• High School Diploma or equivalent (required).
• Associate or Bachelor's degree in healthcare administration or related field is preferred (not required)
• Certified Billing and Coding Specialist (CBCS) Certification is preferred (not required)
• Prior authorization Certified Specialist (PACS) Certification is preferred (not required)

Benefits:

• Health Insurance (3 plans available, including an HSA)
• Dental Insurance
• Vision Insurance
• Ancillary Benefits (Hospital Indemnity, Accident Benefit Insurance, Critical Illness Insurance)
• Employee Assistance Program (EAP)
• Short-Term and Long-Term Disability Insurance
• Basic (Employer Paid) and Supplemental Life Insurance
• 401k plan with Employer Match
• Up to 4 weeks of PTO as well as 16 hours of Floating Holiday
• 90-day and Annual performance reviews which will assess your professional growth potential and possible advancement opportunities.
• Use of Fitness Center and Sauna

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Note:

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.