Billing Specialist

Position Summary:

The Billing Specialist plays a crucial role in the revenue cycle process by ensuring that all billing procedures are executed accurately and efficiently. Reporting to the Revenue Cycle Manager, this position is responsible for preparing and submitting medical claims to insurance companies, reviewing patient bills for accuracy, and working to resolve any discrepancies. The Billing Specialist works closely with other members of the revenue cycle team to maximize reimbursement and ensure a smooth billing process.

Essential Job Functions:

• Claim Preparation & Submission: Prepare and submit accurate and timely medical claims to insurance companies, government programs, and other payers.
• Charge Entry: Accurately enter charges into the billing system based on patient services and coding information.
• Payment Posting: Post payments received from payers and patients to the appropriate accounts, ensuring accuracy in the allocation of funds.
• Denial Management: Review and analyze claim denials, identify the reasons for denial, and take appropriate action to correct and resubmit claims.
• Billing Audits: Perform regular audits of patient accounts to ensure accuracy in billing and coding, and identify any discrepancies or errors.
• Patient Billing: Generate and send out patient statements, responding to patient inquiries regarding their bills, and providing clear explanations of charges and payment options.
• Insurance Verification: Verify patient insurance coverage and benefits prior service delivery and claim submission, ensuring that all necessary information is obtained and recorded.
• Compliance: Ensure all billing activities comply with federal, state, and local regulations, as well as internal policies and procedures.
• Reporting: Assist in generating reports on billing activities, accounts receivable, write-off recommendations and other key metrics for review by the Revenue Cycle Manager.
• Collaboration: Work closely with the coding team, accounts receivable specialists, and other departments to resolve billing issues and ensure a seamless revenue cycle process.
• Process Improvement: Identify opportunities to streamline billing processes and improve efficiency, making recommendations to the Revenue Cycle Manager.

Essential Qualifications:

Certifications/Licenses:

• Must have the ability to obtain CPR & First Aid Certification and an Annual Tuberculosis Test;
• Ability to pass first level and NABS background clearance

During your tenure with WestCare there may be new requirements, including, but not limited to vaccinations that are issued by local, State, Federal, and/or Funders that WestCare may have to comply with. Should this occur Human Resources or appropriate personnel will inform you

Education:

• High school diploma or equivalent required. An associate's or bachelor's degree in healthcare administration, business, or a related field is preferred.

Experience and Competencies:

• Experience: Minimum of 2 years of experience in medical billing or a related field.
• Technical Skills: Proficiency in medical billing software, electronic health records (EHR), and Microsoft Office Suite. Experience with [specific billing software] is a plus.
• Knowledge: Strong understanding of medical billing and coding procedures, insurance claim submission, and payer requirements.
• Attention to Detail: High level of accuracy and attention to detail in processing claims and posting payments.
• Communication Skills: Excellent verbal and written communication skills, with the ability to interact effectively with patients, payers, and team members.
• Problem-Solving Skills: Strong problem-solving abilities with a focus on resolving billing issues and ensuring accurate claim submission.
• Organizational Skills: Ability to manage multiple tasks, prioritize workload, and meet deadlines in a fast-paced environment.

Working Conditions:

• Environment: Office setting, with regular use of computers and telephones.
• Hours: Typical work hours are Monday to Friday, 8am - 5pm, 40 hours a week Full Time