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