Billing Specialist

SUMMARY:     The Billing Specialist is responsible for overseeing the billing process for the patients of Southwest Community Health Center, Inc. Their duties include processing payments on behalf of our patients’ insurance carriers / self-pay patients while maintaining an organized use of time.

SPECIFIC DUTIES AND RESPONSIBILITIES:   All duties are subject to accommodation in accordance with the Americans with Disabilities Act (ADA)

• Perform completion of claims to commercial payers

• Perform self-pay / patient statements

• Process claims, payments, adjustments, and corrections

• Ability to review claims and identify coding issues that may result in denials

• Submit billing data to the appropriate commercial insurance carriers

• Create reports to analyze rejection or denials and payments via Epic utilizing tools such as Power BI Tableau or other data analytics tools to ensure we are receiving the maximum reimbursements

• Achieve maximum reimbursement for services provided based on contracted reimbursement rates

• Resolve denials from commercial and other carriers

• Structure, maintain and report on commercial trends, outstanding A/R, billing inconsistencies and errors

• Financial solutions for patients and/or payment plans of those who may need payment assistance

• Conduct duties in a professional and timely fashion

• Being both detailed and multi-task oriented

• Excellent communication skills with the ability to ensure complete teamwork as well as the ability to work independently

• Ability to escalate identified trends with documentation and propose solutions

• Other related duties as assigned.

QUALIFICATIONS

•         1-2 years of experience in patient and third-party billing and automated billing.
• Knowledge of medical insurance and experience in medical billing and coding.
• Proficient with computers and capable of utilizing E.H.R and E.P.M systems effectively.
• Experiencing using EPIC is highly preferred.
• Excellent interpersonal and communication skills.

EDUCATION AND/OR EXPERIENCE

• High school diploma and/ or Certified in Medical Billing & Coding.

• Associates Degree preferred