Position Details

Billing Specialist

JOB TITLE: Billing Specialist III

WORKSITE LOCATION: GBC Regional Plaza, 6502 Nursery Drive, Suite 100, Victoria TX 77904

STARTING PAY: $15/HR EEOC CODE: Admin Support Workers FLSA STATUS: Non-Exempt

SHIFT: Fulltime; Monday through Friday, 8:00am to 5:00pm

JOB PURPOSE:

Ensures accurate and timely processing and tracking of payments, resolves billing discrepancies, and addresses customer inquiries and concerns regarding billing. Completes other billing functions as deemed necessary. Works under general supervision of the Revenue Manager, with moderate latitude for the use of initiative and independent judgment.

EDUCATION AND EXPERIENCE:

Required: High School Diploma or GED equivalent

Preferred: Two years' experience in insurance billing and collections; previous medical billing experience with an electronic billing system and medical/billing/coding certification a plus.

ESSENTIAL FUNCTIONS and DUTIES:

  1. Billing:
    1. Process billings of Long-Term Care services to Texas Medicaid.
    2. Maintain knowledge of timely filing deadlines for payors.
    3. Review and analyze Clearinghouse transactions for rejected claims and appropriate authorizations. Update corrected claims and submit them to the Clearinghouse for reprocessing.
    4. Verify Program and Payor combination report to adhere to billing rules for maximum billing opportunities.
    5. Maintain and coordinate IDD spreadsheet listing claims with issues and review with IDD staff at least quarterly.
    6. Work billing charge errors associated with payor plan information.
    7. Verify insurance eligibility for denied claims.
    8. Retrieve A & B reports for Long Term Care, Habilitation Coordination and PASRR roll-up process.
    9. Retrieve reports for General Revenue (GR) transfers and apply the GR adjustment.
  2. Posting Payments:
    1. Maintain posting of all Long-Term Care payments in EHR, making necessary contractual adjustments and transfers for customer responsibility. Maintains all related files including scanning and downloading for explanation of benefits.
    2. Research unapplied customer payments and determine where the service payments should be posted to.
    3. Process payor and consumer refunds for overpaid services.
    4. Work with Accounting Department to ensure all payments received are posted and vice versa.
  3. Accounts Receivable:
    1. Collect outstanding accounts receivable balances.
    2. Retrieve explanation of benefits for non-payments. Contact customer service for more complex claims and contact provider services for resolution when needed.
    3. Appeal denied claims. Request and submit medical records to the payor if additional information is needed to expedite a claim. Document insurance status under RWQM in the EHR System.
    4. Maintain a denial log.
  4. Review Consumer Accounts:
    1. Maintain payor plans in EHR System, retrieve insurance ID cards from medical records, and conduct additional research if needed. Retro payor plans to Medicaid start date if the payor backdates the eligibility for new members.
    2. Set-up copays in the EHR System.
    3. Generate and review customer statements.
  5. Provider Schedules:
    1. Update assigned daily provider schedules, eligibility and payor plans, and ensures that financial assessments are current.
    2. Ensures that consumer copays, co-insurance, deductibles, self-pay rates, and MAPS are communicated to front desk staff.
    3. Serve as primary to discuss balances with customers or LAR by telephone or in person as requested.
  6. Other duties:
    1. Responds to Billing Group e-mail inquiries.
    2. Attend monthly Information System (IS) Department meetings to troubleshoot identified claims billing issues.
    3. Attend Managed Care organization monthly meetings with Billing Team to discuss credentialing, reimbursement, or denial issues as requested.
    4. Maintain confidentiality and compliance with federal HIPAA Regulations.
    5. Crosstrain within the billing department as deemed necessary.

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 15lbs, 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

Work site and environmental conditions that apply to this job: Travel by car 5% of time, Inside, Working closely with others, Working alone

CRED/PRIV REQUIRED: No DRIVING REQUIRED: Yes

KNOWLEDGE, SKILLS, ABILITIES, and COMPETENCY:

  1. Program Specific: Must have knowledge of health business office environment with claim submission and accounts receivable. Work requires knowledge of healthcare coding, billing and collection processes including federal and state collection laws, legal collection practices and collection techniques at a level generally acquired through 2 to 3 years of on-the-job training or experience in billing Medicare, Medicaid, Managed Medicaid, Blue Cross Blue Shield, HMO, MCO, and Commercial insurance collections in a healthcare environment. Previous medical billing experience with an electronic billing system a plus. Medical/Billing/Coding Certification a plus. Cross training with department functions.
  2. Communication: Strong written and verbal communication skills to communicate clearly and effectively with strong organizational skills and the ability to interface effectively with all levels of the organization. (#2 through #10 will be the same on all JD's.)
  3. Task management: Ability to perform tasks effectively and efficiently and to handle multiple priorities in a confidential environment. Must have strong attention to detail. Ability to plan and schedule work and implement directives without constant supervision. Must have good organizational skills to achieve multiple deadlines.
  4. Confidentiality: Ability to maintain a strict standard of confidentiality in handling sensitive information, reports, and correspondence.
  5. Conflict resolution: Ability to solve problems and resolve issues.
  6. Interpersonal skills: Interacts with employees' contractors, customers, community, family members, referral sources, governmental sponsoring and funding entities, program auditors, advocacy groups, and the media. Ability to work collaboratively with a team of staff to accomplish the efficient operation of the program by assisting coworkers, as necessary, to meet client needs and contract requirements with no verified complaints. Ability to work cooperatively and productively with supervisors, individuals, co-workers, and groups of people at all levels of activity, contributing to a strong spirit of teamwork. Ability to establish and maintain effective working relationships with staff, other agencies and the public using tact, courtesy, and good judgment.
  7. Code of Conduct, CORE Values: Work behavior must be compatible with Center's Core Values, Culture, Mission and Vision statements, and Policies and Procedures contributing to an environment of problem solving, building trust, conflict resolution, and customer service. Adheres to the professional, ethical and legal requirements set forth in the Center's business Code of Conduct as well as the Corporate Compliance Plan.
  8. Customer service: Demonstrates appropriate responsiveness to internal/external customer needs.
  9. Dress code: Adherence to Center Dress Code to present a professional appearance and conduct when representing the Center.
  10. Fleet: Completes fleet checklist as required. Report all fleet problems directly to the Program Director within 24 hours of identifying problem. Uses GeoTab key fob in fleet vehicles and maintains road safety compliance.

OTHER REQUIREMENTS OR CONDITIONS:

  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. Safe driving record as defined by Gulf Bend Center.
  3. Must have computer experience to include Microsoft Word, Excel (beginner to intermediate level), Outlook, Teams, and Zoom. Ability to type 40 wpm. Ability to operate office equipment (copy machine, fax).
  4. Must complete all training requirements prior to the due date. Attend required training and team meetings. Relias training and any other training required for the role per Center policy.
  5. Must maintain regular and reliable attendance, including compliance with the telework agreement. This is a full-time 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 the 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 applies 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 list 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.