INTERNAL UNION APPLICANTS WILL BE GIVEN FIRST CONSIDERATION

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DATE:8/4/14
STATUS:Regular, Full Time
SALARY RANGE:$34,887.79 - $43,373.39
TITLE:BILLINGS AND CLAIMS PROCESSOR
GRADE:18
DEPARTMENT:Community Support & Treatment Services
LOCATION:555 Towner
UNION AFFILIATION:AFSCME 2733 Unit B
JOB SUMMARY
Under the supervision of a higher classified employee, will be responsible for processing insurance claims for behavioral health care services to Medicare, Medicaid and other third part insurances and from Providers. Process monthly patient billings for self pays, post payments, make any needed adjustments to accounts, handle other discrepancies and reimbursements. Process incoming claims for authorized services. Will communicate with Providers and insurance carriers to clarify issues and ensure timely billing and payment. Prepare and generate a variety of fiscal reports as it relates to claims and reimbursement.
EXAMPLES OF DUTIES
Essential Duties:

  • Prepares, mails and files all insurance claims for payment to Medicare, Medicaid and all third party insurances on a monthly basis for behavioral health services provided. Interact with clinical staff regarding authorization and coding issues.
  • Reviews, adjudicates, and processes claims submitted by providers and prepares for processing through the Accounts Payable function.
  • Enters hard copy claims into the electronic clinical record for Providers that do not access the system directly and adjudicates after entered.
  • Prepares updates on account numbers and rate changes in the electronic clinical record.
  • Prepares State Facility (state psychiatric hospital) billings.
  • Prepares and completes billing for services relating to County of Financial Responsibility arrangements.
  • Works with staff to correct errors detected by the electronic billing system edit check report. Stay current on ICD-9, CPT and HCPCS codes and their proper usage.
  • Resolves medical billing and claim discrepancies by examining and evaluating data and recommends corrective steps
  • Processes account write-offs.
  • Reads, reviews and monitors insurance company rules and regulations, including eligibility for state and federal entitlements.
  • Run aging reports monthly to ensure that account receivables are accurate
  • Generates a variety of computerized reports utilizing the electronic clinical record and/or financial system.
  • Serves as a liaison for internal and external customers regarding billing or claims issues.
  • Assists in designing work processes to enhance efficiency and service provision.
  • Complies with recipient rights reporting requirements and all HIPAA regulations.
  • Maintain working knowledge of software applications used in performance of daily duties.
  • Performs other related work as assigned.
The above statements are intended to describe the general nature and level of work being performed by employees assigned this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
EMPLOYMENT QUALIFICATIONS:
Knowledge of:

  • Medical billing and collections preferably in the behavioral health industry
  • Medicaid allowable service codes
  • Fiscal operations
  • Spreadsheet/database and word processing applications.
Skill in:

  • Working cooperatively in a team setting.
  • Performing simple mathematical functions.
  • Understanding and following a series of complex instructions.
  • Completing repetitive financial tasks with accuracy and without detailed instructions.
  • Operating standard office equipment, including calculator, adding machine, personal computer and telephone
  • Performing repetitive, detail-oriented, and short-cycle work.
  • Performing effectively with the public, internal customers and all levels of management.
  • Working under specific instructions.
PHYSICAL DEMANDS
Duties require sufficient mobility to work in a normal office setting and use standard office equipment including a computer, vision to read printed materials and a VDT screen and hearing and speech sufficient to communicate in person or over the telephone.
These requirements may be accommodated for otherwise qualified individuals requiring and requesting such accommodations.
EDUCATION
  • Formal training in medical billing procedures and requirements. Possession of a high school diploma or its equivalent. An Associate's Degree or Bachelor's Degree preferred.
EXPERIENCE
  • At least two years experience in processing Medicare/Medicaid and commercial insurance claims utilizing an electronic billing system. Strong organizational and interpersonal skills and the ability to work independently. Possess a working knowledge of spreadsheet/database and word processing applications.
This class description intends to identify the major duties and requirements of the job and should not be interpreted as all-inclusive. Incumbents may be requested to perform job-related duties other than those outlined above and may be required to specific job-related knowledge for successful job performance.

FILING DEADLINE: 8/26/14

CONTROL NUMBER: 1408-648-1859-0001

AN EQUAL OPPORTUNITY EMPLOYER

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