Billing Specialist

On-Site Service:

Non-Exempt - Reimbursement

Reports To:

Supervisor, Revenue Cycle Management

The Billing/Coding Specialist works under the direct supervision of the RCM Supervisor and primarily performs duties and tasks relative to billing and reimbursement processes. The Billing/Coding Specialist is responsible for the complete revenue cycle process which includes, reviewing claims prior to submission, submitting claims to the Clearinghouse, following up on the claims and working any rejections and open outstanding claims reports. This position is required to stay abreast of any industry changes and to review and educate front office staff on any necessary changes in the data entry/insurance verification process as it relates to the reimbursement processes.

Essential Duties and Responsibilities

• Review service activity logs (SALS) prior to submission, making sure coding rules are followed for compliant billing
• Submit claims, at least weekly, to all payers per divisional policies and procedures
• Review clearinghouse submission files and correct and resubmit as needed
• Follow HIPAA guidelines to ensure PHI is secure, accessible and accurate for billing purposes.
• Work with insurance companies to resolve unpaid claims
• Review insurance re-authorizations, and/or insurance verification.
• Resolving billing discrepancies, rejections, etc. on a timely basis
• Develop and monitor payment plans
• Respond to billing and/or financial correspondence in a timely manner
• Manage denied claims and efficiently file appeals timely based on payer filing limits
• Follow all policies and procedures of both CCIH and Reimbursement Division
• Electronically verify and monitor consumer insurance status as needed
• Research and resolve open claims from Outstanding claims report
• Generate and distribute billing and collection reports per policies/processes of the division
• Ensure all services are billed based on both Federal and State requirements to maximize reimbursement
• Keep current on all payer and regulatory changes and educate others as needed
• All other duties as assigned

Qualifications and Skills

• Working knowledge of all contracted insurance companies, (e.g., Blue Cross/Blue Shield, Medicare, Medicaid, Private Pay) and their billing requirements
• Analytical thinking ability and extremely detail oriented
• Knowledge of coding requirements/rules and health plan policies and procedure manuals
• Knowledge of billing software programs, Microsoft Excel, and Microsoft Word
• Demonstrated ability to work cooperatively and effectively as a team player with a wide range of professional disciplines.
• Flexibility to respond efficiently to change and new requirements in the reimbursement process
• Highly motivated, proactive and self starter
• Ability to reconcile and/or balance financial documents and accounts
• Excellent administrative and organizational skills
• Strong verbal and written communication skills

Education / Experience

• Minimum of 2-years’ experience in billing within healthcare environment required
• Insurance Billing Certification or Associate Degree in related field preferred
• Certified Procedural Coder preferred.

Credentialing / licensure

SUBMIT RESUMES TO: T. Conte Human Resources
Central City Integrated Health
17950 Woodward Ave
Detroit, MI 48203
FAX NUMBER: (313) 733-1300