Billing Specialist

Socket.dev; Donlontown (NJ); On-site; USD 45,000 - 65,000; Full time

Job summary

Socket.dev is seeking a Billing Specialist to support the Revenue Cycle Department. The role handles a high volume of claims, submits residential OON claims, and serves as a subject matter resource for residential billing.

The position requires timely follow-up with insurers, adherence to billing standards, and collaboration with team members to ensure accurate reimbursements.

Qualifications

• High School diploma with Billing & Coding certification.
• 1 year billing and coding experience.
• Proficient in Microsoft Office and CPT/ICD coding.

Responsibilities

• Generate insurance claims and collect balances.
• Prepare and submit OON claims for residential services.
• Submit appeals and reconsiderations to insurers.
• Follow up with insurance companies on outstanding accounts.
• Ensure timely reimbursements and adherence to standards.
• Investigate denied claims and update records.

Skills

Adaptability

Customer Service

Decision Making

Dependability

Ethics

Interpersonal Skills

Education

CRMS Certification

CPC/CPMA Certification

CCA/CCS/CCS-P Certification

Tools

Microsoft Office

EHR Software

CPT/ICD Coding

Job description

General Description

The Billing Specialist is responsible for providing support to the Revenue Cycle Department. This position manages a very high volume of claims and must work quickly and efficiently to manage the consistent flow of work. This position may also serve as a primary subject matter resource for residential billing.

Tasks & Responsibilities

A. Essential Duties

• Generates insurance claims and collects outstanding insurance balances.
• Prepare and submit accurate OON claims for residential behavioral health services (Residential Billing only).
• Submits appeals and reconsiderations to insurance companies.
• Makes follow-up calls to the insurance companies on accounts with outstanding balances.
• Maintains standards to ensure systematic, consistent, and timely collection follow-up.
• If claims are denied by the third-party payer, the medical billing specialist must investigate the claim, verify its information, and update the database.
• Ensure medical records needed for billing purposes are in client’s charts and/or submitted.
• Completes all payer rejections in a timely manner in accordance with department standards.
• Identifies, separates, and mails claims that require paper submissions for timely submission.
• Monitors provider enrollments to assure that claims process correctly to ensure timely reimbursements.
• Reviews, researches, and amends correspondence/explanation of benefits and makes appropriate adjustments to accounts.
• Identifies and communicates possible system and reimbursement problems to facilitate an efficient and accurate review of the payers.
• Meets billing compliance standards.
• Contact insurance carriers to have claims reprocessed in accordance with contracts and plan benefits.
• Protects Facility value by keeping collection information confidential.
• Update job knowledge by participating in continuing education opportunities.
• Review billing reports identify areas that need attention.
• Provide supervisor with follow up from billing reports.
• Bi-weekly supervision.

B. Additional Duties

• Assists and covers other staff when necessary to maintain high productivity and efficiency in the department.
• As the company continues to grow, additional responsibilities that are essential for the department to be successful will be assigned accordingly.

C. Interpersonal Relations

• Create Meaningful Connections: Demonstrates ability to function effectively as a part of team. Uses outstanding oral and written communication with employees at all levels of the business for support and sharing of information.
• Take Accountability: Take constructive feedback and prevent discourse among our peers.
• Live in the Solution: Critically thinking should be the solution when problems arise. Having the ability to accepts constructive criticism well in an open and non-defensive manner.
• Be Professional: Wear business casual attire (please see dress code policy).

Competencies

• Adaptability
• Customer Service
• Decision Making
• Dependability
• Ethics
• Interpersonal Skills

  Performance Standards & Measurement

  • Compliance with essential and incidental duties; compliance with company policies and procedures.
  • Compliance with state and federal laws and regulations applicable to the business.

  Equipment, Tools & Machines

  • Use of computer, telephone, and other office equipment such as a printer and fax.
  • Use of company network and email domain.

  Working Conditions

  • Air conditioned and well-illuminated office environment and outdoor environment.
  • May have several responsibilities at once. Interaction with others is constant and can be interruptive.
  • Work may be stressful at times due to high level workflow.
  • Availability to work flexible hours including weekends, holidays, and evenings as is required to comply with the purpose of the job and accommodate client needs.
  • Participates in educational training, orientations, or compliance programs as needed to maintain competency.
  • If you must leave your employment with our company, we request employees to give us at least 14 days resignation notice in writing.

  Demands

  • Enthusiastic self-starter operating with sustained energy and showing great initiative.
  • Comfort working with a diverse base of support, including members, employers, providers, colleagues, community leaders, volunteers, non-profit organizations, vendors, etc.
  • Excellent interpersonal and communication skills, including ability to read, write, spell in English legibly and without excessive grammatical or communication errors.
  • Talk and hear both by person and by telephone; ability to speak clearly and effectively using proper grammar before patients, employees and business partners, among others.
  • Excellent organizational skills.
  • Accepts constructive criticism well in an open and non-defensive manner.
  • Ability to manage conflicting priorities. Ability to maintain a positive work ethic and a congenial attitude in the face of a high-pressure environment.
  • Ability to function independently and with flexibility.
  • Ability to work under pressure, handle multiple tasks and interruptions.
  • Occasional lifting of moderately heavy office supplies; ability to lift supplies for community events, trade shows, conferences, and other marketing opportunities applicable to the organization; ability to lift, push or pull up to 25lbs.
  • Ability to sit, stand, or walk for extended periods of time.
  • Must have strong computer skills to meet Microsoft Office and Electronic Health Record software requirements.

  Qualifications

  Education:

  • High School Diploma or equivalent; Billing and Coding Certification from one of the following national certification exams:
  • American Medical Billing Association - Certified Medical Reimbursement Specialist (CRMS) Board Exam
  • AAPC - Certified Professional Coder's (CPC®,) Certified Outpatient Coder (or CPC-HCOC™) [formerly CPC-H®,] Certified Inpatient Coder (CIC™,) or Certified Professional Medical Auditor (CPMA®) Board Exam
  • American Health Information Management Association - Certified Coding Associate (CCA®,) Certified Coding Specialist (CCS®,) or Certified Coding Specialist Physician-Based (CCS or CCS-P®) Board Exam - The CCS & CCS-P credentials require experience in addition to the education

  Experience:

  • Billing and Coding: Minimum of 1 year
  • CPT and ICD coding
  • Computer literate: Microsoft Office (Excel, Word, and PowerPoint) required.