What are the responsibilities and job description for the Billing Specialist position at Central City Health?

Billing Specialist

Pay Rate : Up to $23.00 (hourly)

Website : www.centralcityhealth.com

You May Also Submit Your Resume : jobs@centralcityhealth.com

Who We Are : Central City Health (CCH) has been serving the underhoused and at-risk population in metro Detroit since 1972, by providing integrated healthcare services. Our services include primary and pediatric care, dental care, behavioral and SUD care, supportive housing, and community re-entry services, to name a few. In 2024, our President / CEO, Dr. Kimberly Farrow-Felton received the esteemed Healthcare Hero Award from Crain’s Detroit Business honoring her exceptional contributions to the health and well-being of our community.

Our Mission : To achieve wellness in the community by providing an array of primary and behavioral health care, housing, and substance abuse services with dignity and respect.

Our Core Values : CCH is guided by a set of values in fulfilling our mission. Some of our values include :

An environment that supports health and recovery.
Person centered principles in the delivery of care.
An environment characterized by cultural sensitivity, integrity, teamwork and trust.
A commitment to service excellence and continuous quality improvement.
Persons served take both an active part in their treatment and the organization.
An atmosphere of welcoming and accessibility to people seeking our services that assures “no wrong door.”

You Get….

14 Paid Holidays Annually.

18 PTO Days (less than 1 Year; 27 Days on 1st Year Anniversary).

Benefit Coverage after 30 Days : Medical / Dental / Vision / Short-term Disability.

Company-Paid Life Insurance.

Retirement Savings 403(b).

Tuition Reimbursement.

Continuing Education Allowance.

GENERAL DESCRIPTION :

Under the leadership of the Manager of Revenue Cycle, the Billing Specialist, will work to bridge the gap between the Medical Care, Behavioral Health, and Dental Care providers, patients, and the insurance companies by making sure the correct insurance information is updated and added to the electronic medical record along with any authorizations needed before the patients are serviced. This individual will ensure timely and accurate reimbursements by reviewing and correcting any internal claim errors before submission to the electronic billing clearinghouse. Upon claim submission to the proper clearinghouse, the biller will review the uploaded claims to correct any front-end edits that could prevent the claim reimbursements.

RESPONSIBILITIES :

Prepares complex claims for various service lines (behavioral health, primary care, SUD, etc.).

Analyzes, researches, and resolves various claims-related issues (rejected claims, unbilled claims, and / or improperly adjudicated claims) with limited supervision.

Initiates investigation of questionable claims; may refer recommendations to Revenue Cycle Leadership.

Keeps Revenue Cycle Leadership abreast of claims-related issues that affect the proper adjudication of claims

Completes required reports as requested, (i.e., Billed Claims Report, Service Activity Log, (SAL) Reports, Medical Record Request Reports, Claims Payment Reports, etc.).

Consistently checking members’ eligibility.

Refers complex or unusual issues to Revenue Cycle Leadership for guidance.

Meets and exceeds production quantity and quality standards, as determined by Leadership.

Prepares claims adjustments, as necessary (i.e., claims paid to wrong provider, refund requests, overpayments, etc.)

Oversees projects within the scope of revenue cycle as specified by Leadership.

Participates in a team concept, which promotes an effective and efficient department.

Interacts with Medical Services, Mental Health Services, and Dental Services to resolve claims-related issues

Maintains confidentiality of patient information.

Performs other duties as assigned.

EDUCATION AND EXPERIENCE :

High school diploma or GED required; associate or bachelor’s degree preferred.

Three (3) to five (5) years of recent medical billing experience required.

Minimum of two (2) years of claims processing experience of both professional and facility claims highly preferred.

Experience with AthenaOne, (similar systems), PCE Systems, and Denticon highly preferred.

Demonstrated knowledge of ICD, HCPC, and CPT coding methodologies; medical billing or coding certification highly preferred.

Knowledge of behavioral health, primary care and dental, professional and facility claims processing, payment, and denial resolution as well as diverse insurance background preferred.

Demonstrated knowledge of CMS, Third Party Payers, and Managed Care Guidelines.

Good working knowledge of FQHC and Community Mental Health claims.

Demonstrated knowledge of the patient scheduling and registration process.

Must maintain confidentiality relating to treatment in accordance with HIPAA guidelines.

High-level interpersonal skills to interact effectively with clinical staff, providers, patients, and other individuals outside of the Advantage Health Centers organization.

About Central City Health :

Central City Health will be recognized in the community as a premier provider of accessible comprehensive behavioral and physical health care, substance abuse services, and housing opportunities that lead consumers toward self-sustainability. Our mission is to achieve wellness in the community by providing an array of primary and behavioral health care, housing and substance abuse services with dignity and respect.Vision

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