This position is responsible for the day-to-day billing and claims functions, primarily related to accounts receivable/billing according to Authority policies and procedures.
Generate appropriate billing for all assigned 3rd party payers, secondary payers and COFR payers for all services, voiding and correcting errors, address and reprocessing rejections, and verifying waterfall through appropriate guidelines of insurance payers.
Ensure that Medicaid is payer of last resort.
Correspond with staff as necessary on issues arising from payer’s rules/regulations.
Process all assigned Provider Network claims through the EMR’s claim adjudication process within the appropriate guidelines of the Agency and PIHP.
Send claim rejections to appropriate providers and follow-up as needed.
Submit invoices to the Finance staff as appropriate.
Requires monitoring, analyzing, claims processing, completion of billing batches, and other documents to be completed in conformance with the positions established work plan consistent with formats, time frames and other assignments as identified, as needed assuring timeliness and accuracy.
Associate degree in accounting, Business Management, Health Administration or other related field.
Certification as CPC, CPC-A, or CMBS
In lieu of degree the following may be considered:
b) Equivalent of two (2) year degree with relevant courses with two (2) years experience,
c) A minimum of five (5) years progressive responsibilities in billing and claims procedures.
Experienced in advance accounting procedures.
Knowledge in day-to-day accounting functions primarily related to accounts receivable.
Experience with billing behavioral health services as well as the reimbursement of behavioral health services across all service lines.
Knowledge of service coding, as well as best practices related to billing.
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