Reimbursement Specialist

Classification General Statement:

The Reimbursement Specialist processes and documents MCCFL services to ensure the timely collection of receivables from Medicaid, Medicare, and other reimbursement sources. This position compiles a variety of reports specific to accounts receivable activities, informs management of billing issues, and processes monthly client statements.

Job Specifications: Any qualifying combination of education, licensure and experience that demonstrates the ability to perform the duties of the position is qualifying. This would typically include:

· A high school diploma or equivalent, AND

· Four (4) years of responsible bookkeeping experience that includes demonstrated skill in the use of automated financial system software AND / OR medical billing in a healthcare environment that includes knowledge of procedural and diagnosis codes (desirable)

· Bilingual fluency (English/Spanish) is desired (but not required).

· Must possess a valid Oregon or Washington Driver’s license and be insurable for travel between business offices or possess an alternative reliable mode of transportation.

· Must pass all criminal history check requirements as required by ORS 181.536-181.537 and in accordance with OAR 407-007-0200 – 407-007-0370.

Essential Responsibilities of the General Classification: (The following list represents the essential responsibilities of the position. It does not, however, include all of the duties the position may be assigned.)

· Compile and review billing data to ensure accuracy of all billing information including Current Procedural Technology (CPT) codes, Oregon Health Plan (OHP) codes, cost center codes, bundling of services, and total fees.

· Analyze, understand and interpret billing software upgrades and coding change effects on customers’ accounts receivables.

· Perform monthly processing of outstanding third-party billing.

· Monitor aged accounts receivable for assigned payer groups monthly.

· Take appropriate action to resolve open balances for non-OHP clients.

· Inform clinicians of client balances over 60 days for counseling on collection.

· Prompt follow-up and correction of billing errors, rejections, insurance company errors and inquiries.

· Send monthly statements to clients and separate out special handling statements for alternative processing.

· Perform data entry tasks in MCCFL’s billing system including third party payments, electronic health records data, fee adjustments as noted on reconsideration forms. Review data entry work to ensure accuracy.

· Inform screeners and providers of client insurance eligibility within 24 business hours of notification for new and re-opened clients. Verify coverage for OHP clients on community partner invoices notifying managers and supervisors of client’s eligibility.

· Maintain batched billing data and upload to the clearinghouse on a scheduled basis.

· Check daily activity in billing system, input corrections and advise Business Service of changes.

· Prepare and submit encounter measurement data for Mental Health (MH) and Alcohol & Drug (SUD) services to MCCFL’s affiliated Coordinated Care Organizations (CCO) in the format requested, either electronically or paper.

· Confirm OHP eligibility thru Medicaid Management Information System (MMIS).

· Provide assistance and support to clients in the OHP enrollment process.

· Respond to client/staff inquiries regarding billing status providing resolution information in a professional manner.

· Regular and reliable attendance; professional communication; compliance with confidentiality standards.

· This job description does not reflect all duties and responsibilities of the Reimbursement Specialist position.

Other Required Knowledge, Skills and Abilities:

Knowledge: Knowledge of the principles and practices associated with modern bookkeeping including accounts receivable, billing, and recordkeeping. Knowledge of standard insurance contracts, third party agreements and billing requirements that affect the work. Knowledge of prioritized OHA rules/procedures, insurance coverage, and MCCFL policies that affect the work. Knowledge of medical licensure levels and credentialing requirements for preferred status with contracted insurance companies. Knowledge of electronic health record systems, electronic billing systems, and automated financial systems. Knowledge of Federal, State and local agency laws governing fees, payments and HIPAA privacy. Knowledge of OHP enrollment guidelines and processes.

Skill: Strong skill and accuracy in keyboarding and data entry; strong skill mathematics; skill in the use of standard office software, including MS Excel and Word; skill in the use of database software; skill in the use of automated bookkeeping software.

Job Type: Full-time

Pay: $20.03 - $22.08 per hour

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Tuition reimbursement
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

COVID-19 considerations:
All consumers are encouraged to wear a mask and commonly touched surfaces are frequently sanitized.

Education:

• High school or equivalent (Required)

Experience:

• Bookkeeping: 4 years (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: One location

Salary : $20 - $22