As a member of the Finance team, the Billing Specialist is responsible for the claim balance of specifically assigned accounts. The role includes obtaining payor authorizations, ensuring proper claim and modifier coding, communicating with clinical staff and insurance companies to resolve issues, resubmitting and adjudicating denied or rejected claims, and applying payments as needed within the electronic health record system and web-based clearinghouse.
This position reports directly to the Contracts and Billing Supervisor.
Essential functions
- Process timely and accurate authorizations for patient services.
- Ensure claims are processed timely and with correct data points.
- Support identification of issues and implementation of corrective actions and process changes.
- Manage accounts receivable aging to ensure outstanding balances are resolved in a timely manner.
- Identify the basis for denied claims, communicate corrective actions, and resubmit claims where appropriate.
- Apply payments to client accounts in a timely manner and in accordance with month-end cutoffs.
- Develop client statements and communicate client balances as needed.
- Complete billing audits as required.
- Participate in ad hoc projects related to billing, collections, or denials.
- Participate in billing and intake-related meetings and provide insight related to billing and authorizations.
Working conditions
- This position has the potential to work remotely after the initial 90 days and upon supervisor approval.
Requirements & Qualifications
Required qualifications
- Coding certification
- Experience with electronic health record systems
- Billing clearinghouse knowledge
- Experience calling or inquiring electronically with insurance companies to assess claim status
- Knowledge of diagnosis, billing codes, and modifiers
- Experience with accounts receivable aging
Knowledge, skills, and abilities
- Advanced knowledge of coding, modifier usage, and denial reason codes
- Proficiency in Microsoft Office applications, especially Excel
- Proficiency in web-based insurance portals and billing clearinghouses
- Proficiency in electronic health systems
- Strong verbal and written communication skills
- Strong organizational skills and attention to detail
- Ability to maintain confidentiality of sensitive information and documents
- Ability to prioritize responsibilities and complete work in a timely manner
Other requirements
- DHS background check approval
- Successful completion of drug test upon hire
- Documentation of tuberculin test and/or evaluation with negative results or evidence of non-communicability
Location
Portland, Oregon, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
1 month ago