BH BILLING SPECIALIST

Company: Care Resource
Location: Fort Lauderdale
Posted on: May 24, 2023

Job Description:

Bills Behavioral Health encounters in NexGen -for Ryan White, Commercial Insurance, Grants, and FQHC patients. Reviews patient accounts and notes to ensure accuracy on insurance and billing. Verifies proper ICD-10 coding is entered in the practice management system based on the services being performed by BH providers. Collects delinquent accounts by establishing payment arrangements with patients; monitoring payments; following up with patients when payment lapses occur. Posts pending behavioral health payments in the EMR and Abila MIP accordingly. Reconciles third party physician reimbursements with monthly Ryan White invoice. Reconciles third party medical HCFA approvals with outstanding HCFA's to be paid. Responds to providers related issues regarding reimbursements, unbillable codes, incomplete/insufficient documentation, and patient concerns. Use various systems to track outstanding claims/payments. Perform other assigned tasks and duties necessary to support the billing department including monthly accounts receivable. Reviews the unresolved encounters report regularly to capture services for which charges were not appended by the different departments. Reviews all clinical progress notes for accuracy and completeness. Obtain necessary missing information from key individuals prior to processing of claims. Validates denial reasons and ensures coding is accurate and reflects the denial reasons. Generates appeal based on dispute reason and contract terms specific to the payer. Follows specific payer guidelines for appeal submission. Escalates exhausted appeal efforts for resolution. Works payer projects as directed. Researches contract terms/interpretations and compiles necessary supporting documentation for appeals. Escalates denial or payment vairance trends to management for payer escalation. Create invoices for grant based billing for submission. Utilizes external portals for grant billing. Administration, Auditing and Compliance Supports all health center exteranal audits as necessary by providing financial reports and documentation as requested. Reviews patient statements for accuracy, and makes corrections as needed. Reviews patient returned address mailings and ensure timely resubmission. Provides monthly billing/collections reports as needed. Ensures billing is conducted in a manner that is consistent with overall -department protocol, and in compliance with Federal, State and payor regulations, guidelines, and requirements. Maintains filing system for all billing related documents. Ensures confidentiality and security of all financial and patient files. Attends meetings related to medical, behavioral health and dental billing as needed. Culture of Service: 3 C's Compassion Greets internal or external customer (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language Listens to internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring an understanding of the request and providing appropriate options or resolutions Competency Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered Commitment Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure prompt and effective response is provided Safety Ensure proper hand washing according to Centers for Disease Control and Prevention guidelines. Understand and appropriately acts upon assigned role in Emergency Code System. Understand and perform assigned role in health center's Continuity of Operations Plan (COOP). Other Provides outstanding customer service to both internal and external customers using the Health Center's 3C's of service. Other duties as assigned. JOB SPECIFICATIONS Education: High School diploma required. Associates degree in related field is preferred. Training and Experience: At least two years of medical billing and/or denials management experience required. Licenses and/or certifications: Medical billing training or equivalent experience is required, coding certification -a plus. Job Knowledge and Skills: Computer knowledge should include Microsoft applications (Word, Excel, Outlook), MIP Fund Accounting software, Greenway Intergy EHR, and Dentrix EDR(a plus). Bilingual (English-Spanish) is helpful. Excellent oral and written communication skills are required to interact with external customers and vendors. Must be detail-oriented and possess good time management skills.Good organizational and decision- making skills are required to ensure that transactions are properly processed in accounting software and the EHR. Ability to work with multicultural and diverse population is required. Contact Responsibility: The responsibility for internal and external contacts is important. PHYSICAL REQUIREMENTS This work requires the following physical activities: constant sitting, hand/finger dexterity, talking on the phone, and hearing/ visual acuity. Also it requires frequent walking and talking in person and occasional bending, standing, and stretching/reaching. Work is performed in an office setting. Travel Required No . Own transportation is required. Work is performed In office setting. QualificationsSkillsRequired Checking for Accuracy Expert Expert Commitment Expert Compassion Expert Expert Cooperation Expert Coordination Expert Expert Customer Service Expert Documentation Expert Integrity Expert Interpersonal Skills Expert Microsoft Office Expert Multitasking Expert Expert Problem solving Expert Quick Thinking Expert Telephone Expert Verbal Communication Expert Expert Phone Systems Expert BehaviorsRequiredTeam Player: Works well as a member of a group Enthusiastic: Shows intense and eager enjoyment and interest Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well MotivationsRequiredFlexibility: Inspired to perform well when granted the ability to set your own schedule and goals EducationRequiredHigh School or better.PreferredAssociates or better in Health Administration or related field.ExperienceRequired2 years: At least two years of medical billing and/or denials management experience required

Keywords: Care Resource, Fort Lauderdale , BH BILLING SPECIALIST, Accounting, Auditing , Fort Lauderdale, Florida