Billing Specialist

Location: TBD – Fully Remote Is an Option

Supervisor: Practice Manager

Hours: FTE 40 hours/week

Compensation: $21.00-$23.50/hour

Primary Function: 

The Billing Specialist assists in all medical/mental health billing functions, including, but not limited to acquiring authorizations, billing to appropriate insurance plans, re-submitting insurance rejections, and tracking insurance and patient payment accounts. The Billing Specialist works independently with support from the Senior Billing Specialist.

The Billing Specialist may perform other administrative tasks as requested by the staff, and will be asked to assist the Practice Manager and People & Culture Manager with special projects as needed.

Job Responsibilities:

• Verify patient insurance coverage utilizing phone or online portals.
• Daily eligibility checks for all OHP plans.
• Submit prior authorizations to insurance via payer-specific online portals or by fax.
• Follow up on pending/denied authorization requests.
• Daily visit count for certain payors.
• Read and interpret insurance explanations of benefits (EOBs).
• Review charge submission for accuracy (POS, MODs, Telehealth guidelines per payor).
• Review and resubmit clearing house rejections.
• Print CMS Forms for payers (this also includes secondary claims).
• External claim entry via online portal for specific payers.
• Resolve insurance claim rejections/denials, and non-payment of claims by payor.
• Draft effective appeals to insurance companies.
• Accurate posting of all insurance payments, patient payments, and approved write-offs in our Electronic Health Record system.
• Resolve all custom and system driven edits, unbilled and exclusion errors in a timely manner.
• Research and process insurance refund requests.
• Utilize monthly/quarterly aging accounts receivable reports to follow up and maintain on unpaid claims or patient payments.
• Generate patient billing statements once a month.
• Process daily payments for patient accounts.
• Reviews and monitors patient accounts and collects outstanding patient balances.
• Investigate all mail returns and update the system, take appropriate action if the patient has terminated care.
• Maintain open communication with patients regarding balances, insurance benefits and coverage.
• Establishes payment plans for patients and monitors payment plans on a regular basis.
• Tracks credit card errors and manages client contact around billing issues.
• Notifies and communicates with clinicians in a clear and concise manner.
• Answers incoming calls to the billing department and resolves patient billing issues.
• Work as a liaison with other departments to facilitate problem solving and data collection appropriate to patient and insurance billing.
• Complete all tasks, voicemails and emails daily.
• Maintain working knowledge of state and federal billing guidelines.
• Follow HIPAA guidelines in handling patient information. 
• Regularly meet with the Practice Owner to discuss and resolve reimbursement issues or billing obstacles.
• Perform other duties as assigned.

Essential Job Requirements:

• 2 or more years of experience in medical/mental health billing.
• Working knowledge of Insurance Coordination of Benefits.
• Working knowledge of Medicare and Medicaid and commercial insurance.
• Working knowledge of Microsoft Excel, Google Suite (sheets, docs, and slides), and EHR systems.
• Knowledge of ICD-10 CPT billing codes for mental health.
• Problem solving, detail oriented, communication, and organizational skills.
• Ability to work independently.
• Ability to handle multiple tasks simultaneously.
• Ability to interface with colleagues and patients of any race, ethnicity, gender, sexual orientation, religion, class, ability, et al.
• Demonstrated competence and humility in terms of race, ethnicity, gender, sexual orientation, religion, class, ability et al, when engaging with patients/public.
• Demonstrated commitment to the preservation of a workplace that embraces diversity.

Performance Requirements: 

Knowledge: 

• Knowledge of or willingness to learn the practice’s policies and procedures. 
• Knowledge of or willingness to learn industry specific terminology and insurance practices. 
• Knowledge of grammar, spelling, and punctuation, for effective and appropriate communication.
• Knowledge of web-based computer programs and applications in an Apple/Mac environment
• Demonstrate a strong understanding of HIPAA policies and regulations

Skills: 

• Use office equipment, and handle and file paperwork adequately.
• Handle incoming phone calls and respond or resource appropriately. 
• Communicate effectively, both verbally and in writing. 
• Gather, interpret, and report insurance information. 
• Navigate patient privacy with critical thinking and follow through.

Abilities:

• Demonstrate compassion: Employees sees people during moments of trauma or crisis, where they and their family are vulnerable or in pain
• Demonstrate patience: Being patient with people who may have trouble communicating or understanding what is happening is important
• Ability to work effectively as a team member, and to communicate clearly, compassionately, and respectfully, with medical and mental health professionals, as well as with administrative support staff
• Ability to interpret and understand insurance benefits.
• Ability to flexibly respond to changing demands within the work environment.
• Ability to organize and prioritize tasks, time, and responsibilities effectively, as well as to work independently and with minimal supervision.
• Ability to establish and maintain effective working relationships with patients, employees, and the public.
• Ability to function proficiently in a web-based computer environment.
• Work with Mac OS & GSuite

Equipment Operated: Standard office equipment, including computers, copiers, printers, telephones, etc. 

Work Environment: When working from a PMHW office, the position is in a well-lit office environment. Varied activities including sitting, standing, walking, reaching, bending, and lifting. 

Mental and Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder. Ability to tolerate mental and emotional distress as an anticipated aspect of the position. May require working under stressful conditions. 

This description is intended to provide only the basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as the practice’s needs evolve. Regular and predictable attendance is an essential function of every job.

The requirements described above are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. By signing below, you acknowledge that you are able to perform the Essential Functions of this job, with or without accommodation. If an accommodation is needed, you acknowledge that you have been given an opportunity to discuss this with People & Culture.

Portland Mental Health & Wellness offers a competitive benefits package for full-time employees that includes:

• Paid health leave (40 hrs to start)
• Paid holidays (48 hours to start)
• Paid vacation (40 hours to start)
• Health, dental, vision insurance
• Employer Paid Life/AD&D
• Voluntary Short Term Disability
• Monthly TriMet Transportation Pass covered at 100%
• 401K retirement with 3-4% company match once eligible
• Quarterly profit sharing 
• Enrollment with Student Loan Tutor
• 20% discount on vitamins & supplements through Wellevate

This description is intended to provide only the basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as the practice’s needs evolve. Regular and predictable attendance is an essential function of every job.

The requirements described above are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If an accommodation is needed, you have an opportunity to discuss this with Human Resources.