Billing Specialist

Job Code: 29-2072

Salary: $15.63 - $31.68

Status:  Non-Exempt Full-time, Permanent

Location:  Health Services

Department:  Business Office

Reports to:  Revenue Cycle Manager

Telecommute: No

Fleet: No

SUMMARY:  Under the direction of the Revenue Cycle Supervisor, the Billing Specialist in Third Party Billing and Accounts Receivable will compile, process and maintain third party billing of and Accounts Receivable of Health Services in a manner consistent with medical, administrative, ethical, legal and regulatory requirements in all areas of the Business Office. The Billing Specialist assumes responsibility for third party billing and accounts receivables, including the timely submission of claims to third party payers, rebilling, posting payments and adjustments, aged/open claims follow-up, and denial management.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: 

• Responsible for the accurate and timely preparation and submission of claims to third party payers and responsible parties according to Business Office policies and procedures.
• Responsible for maintenance and control of unbilled claims for accounts receivables.
• Run and review system generated reports daily to identify claims to be billed.
• Prepares and submits New York State Managed Care Supplemental Payment Program billing.
• Prepares and submits pharmacy billing in Script Pro Pharmacy software.
• Prepares and submits claims to third party payers within a 48 hour time period.
• Responsible for the re-submission of denied/corrected claims and follow up on aged/open claims according to third party billing guidelines.
• Notifies supervisor of all claims deemed un-billable (i.e. beneficiaries), along with reasons and supporting documentation required for an adjustment for reconciliation of claims.
• Verifies and updates patient’s alternate resources in RPMS/Script Pro Pharmacy software.
• Maintains professional telephone etiquette in all contacts with third party payers and patients.
• Maintains up-to-date knowledge of third-party billing policies and procedures, (including Medicare, Medicaid, and private insurance).
• Payments must be posted within 72 hours from receipt of supporting documentation. An A/R log shall be kept to identify when batches were received and posted. Unposted and unallocated batches will be reviewed, researched and worked daily.
• Reconciles account balances; reviews records and source documents to identify sources of discrepancies; and determines the entries required to bring the account to balance.
• Performs third party billing collection posting in RPMS. Receives and reviews all explanation of benefits and remittances from third party payers. Identifies and records proper check numbers on each batch and posts to the appropriate departments. Audits all documents received for completeness and accuracy; performs analysis to determine whether payments are complete, timely filed and in accordance with Business Office policies and procedures.
• Processes secondary/tertiary billing after posting payment of initial claims.
• Reviews Age Report for all third-party payers and completes follow-up on unpaid bills in Third Party Billing within 45 days.
• Performs all claims billing and follow-up for Partridge House.
• Examines accounts or resolves difficult reconciliation requiring an analysis of adjustments and corrective entries in the RPMS system.
• Attends meetings/trainings as requested by the Business Office Manager/Revenue Cycle Supervisor.
• Scans all documentation in OnBase for Business Office electronic financial records.
• Assures HIPAA compliance with all billing practices.
• Researches pharmacy insurance rejections and unbilled claims on the pharmacy daily cash report, performs required edits, and rebills claims electronically to third party payers.
• Follows up via telephone with Script Pro/Insurance for technical assistance and resolution of pharmacy billing issues/concerns.
• Monitor prior authorizations required from insurances on the pharmacy daily cash report and notify pharmacy staff/medical providers of plan requirements.
• Other related duties as assigned (including Patient Registration, Health Information Management, Purchased/Referred Care, Accounts Payables, and Referrals).

SUPERVISORY RESPONSIBILITIES:There are no supervisor requirements for this position.

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.  Due to the sensitive nature of information within the Business Office, must maintain strict confidentiality at all times.

EDUCATION and/or EXPERIENCE: 

• High School Diploma or equivalent, AND
• 1-year medical office experience
• 2 years billing experience preferred.

OTHER SKILLS and ABILITIES: Strong oral and written communication skills required. Must have excellent computer skills including word and excel.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

The Saint Regis Mohawk Tribe strives to be an equal opportunity employer dedicated to the policy of nondiscrimination based on race, sex, marital status, sexual orientation, religion, national origin, age, physical disability, veteran status or any other non-job related factor. 

The successful candidate must pass a test for illegal substances prior to employment being confirmed. 

The successful candidate must pass a criminal background check prior to employment.

The successful candidate must complete a PPD test.