Billing Specialist

Location: Portland, OR (with remote flexibility)
Supervisor: Practice Manager
Employee Classification: Non-Exempt (Hourly), Full-Time
Hours: Full-Time, 40 hours per week
Compensation: $25.85-$28.25/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 Human Resources Manager with special projects as needed. This role offers some flexibility, allowing for the person who fills it to work either in person at one of our office locations or remotely, as long as you are situated within or close to the Portland Metropolitan Area in Oregon or southwest Washington.

Essential Functions:

• 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 and patient payments 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.
• Answers incoming calls to the billing department and resolves patient billing issues.
• Work as 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 Manager to discuss and resolve reimbursement issues or billing obstacles.
• Perform other duties as assigned.

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
• Demonstrate solid understanding of confidentiality

Skills: 

• Situational critical thinking
• Use office equipment, including computers, phones, cameras 
• Handle and file paperwork properly
• Handle incoming phone calls and electronic communication, responding professionally and/or resourcing 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 empathy & compassion: Employees see 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 all staff, including mental health professionals, administrative staff, and all leadership
• 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, and work independently with minimal supervision
• Ability to establish and maintain effective working relationships with the entire PMHW team, vendors, and the public
• Ability to function proficiently in a web-based computer environment

Minimum Qualifications:

• 2 or more years 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 Workspace (sheets, docs, and slides), and EHR systems.
• Knowledge of ICD-10 CPT billing codes for mental health.
• Demonstrate competence and humility in terms of race, ethnicity, gender, sexual orientation, religion, class, ability et al
• Demonstrate commitment to the preservation of a workplace which embraces diversity
• Demonstrate commitment to confidentiality of patient and employee information
• Communicate professionally and effectively with patients and clinicians, always providing stellar customer service
• Answer phone systems with excellent etiquette – a warm/friendly tone, articulate, and providing understandable responses to questions or concerns
• Demonstrate a strong understanding of HIPAA policies and regulations
• Demonstrate a strong attention to detail and organization
• Demonstrate patience: being patient with people who may have trouble communicating or understanding what is happening is imperative for this position
• Follow policies and procedures to contribute to the administrative efficiency of the practice, taking initiative to suggest and develop those that may be needed
• Demonstrate strong computer skills including web based systems
• Ability to work with Mac OS & Google Workspace

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. 

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

• Paid Time Off (40 hours per year, to start)
• Paid Health Leave (40 hours per year)
• Paid Floating Holiday Hours (80 hours per year)
• Medical and Vision Insurance – Kaiser (choice of three plans) – Covered at 70%
• Dental Insurance – Principal – Covered at 70%
• Employer Paid Life and AD&D Insurance – Principal
• Voluntary Additional Life and AD&D Insurance – Principal  
• Voluntary Short Term Disability Insurance – Principal 
• Voluntary Critical Illness Insurance – Principal 
• Voluntary Accident Insurance – Principal 
• Flexible Spending Account, Health Care – Ameriflex
• Flexible Spending Account, Dependent Care – Ameriflex 
• Commuter Benefits – Choice of One Below:
  • Monthly TriMet Transportation Pass – Covered at 100%
  • Parking Reimbursement – Up to $100 per month
• 401K Retirement Plan – Up to 4% Company Match Once Eligible
• Quarterly Profit Sharing Incentive
• Annual Administrative Continuing Education Allowance
• Enrollment with Student Loan Tutor
• 20% Discount on Vitamins & Supplements Through Fullscript
• Discounted Monthly Membership with Müv Fitness
• Limited Access to Columbia Sportswear Employee Store

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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 an opportunity to discuss this with Human Resources.