Billing Specialist

This job involves managing billing and payment processes for services provided by Prairie Ridge, while also maintaining confidentiality, professionalism, and customer service standards. Responsibilities include communicating with third-party payors, monitoring pre-certifications, completing billing and claims submissions, resolving billing denials, handling patient payments, and providing necessary information for collections and refunds. Cafeteria Plan Benefits for fulltime employees include: health, dental, vision and supplemental insurances, FSA/Daycare reimbursement, employer sponsored short and long term disability, and 401k. 

TASKS AND RESPONSIBILITIES

1. Treat all individuals with dignity and respect while maintaining agency standards of confidentiality, professionalism, and objectivity. 
2. Maintain/Assist all confidentiality requirements and regulations as outlined in CARF policies and procedures
3. Communicate with third-party payors regarding payment for services received by covered individuals. This includes oral and written communications.
4. Monitor third-party payor pre-certifications and reviews and notify counselors when they need to be completed.
5. Complete billing for services provided in each level of care within a week of the date the services were provided.
6. Generate and send claims for services provided to covered individuals to third-party payors on a weekly basis.
7. Work and resolve billing denials.
8. Generate and send statements to patients on a monthly basis through POS.
9. Receive and record payments made by patients in person at 320 North Eisenhower Avenue. A receipt will be given the patient and the payment properly safeguarded until deposit.
10. Follow up and resolve denials of claim by third-party payors to determine the reason for denial.
11. Follow up and resolve outstanding third-party payor billings that are older than 90 days.
12. Accept and answer all questions asked by patients or interested parties regarding charges for services provided by Prairie Ridge.
13. Provide information about patient accounts that are to be turned over for collection to the Billing Supervisor for approval on a monthly basis.
14. Provide information about refunds that are due to be paid to patients on a monthly basis to the Billing Supervisor for approval.
15. Provide information about the patient accounts that need to be adjusted or written off to the Billing Supervisor for approval on an as needed basis.
16. Perform other duties as assigned by Billing Supervisor or designee.

QUALIFICATIONS

1. Understanding of the mission of Prairie Ridge and the patients we work with.
2. Proficiency in managing manual and computerized data collection systems.
3. Minimum of 2 years’ experience in medical billing.
4. Excellent oral and written communication skills.
5. Ability to meet the public and agency patients in a warm, helpful manner.
6. Experience in preparing and filing insurance claims.
7. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel objects, tools, or controls; and talk or hear. The employee frequently is required to walk and stoop, kneel, crouch, or crawl. The employee is often required to stand, reach with hands and arms, and climb or balance.
8. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or more up to 35 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and the ability to adjust focus.