Billing Specialist

Advantage Behavioral Health; Marlton (NJ); On-site; USD 42,000 - 65,000; Full time

Job summary

Advantage Behavioral Health is seeking a Billing Specialist to support our Revenue Cycle Department. You will generate insurance claims, collect balances, and manage a high-volume residential billing workflow.

Responsibilities include submitting OON residential claims, handling appeals, performing follow-ups with insurers, and ensuring timely reimbursements while maintaining patient confidentiality and compliance standards.

Qualifications

• Billing and Coding Certification from national certification exams.
• 1 year billing and coding experience.
• Proficiency with CPT and ICD coding.

Responsibilities

• Generates insurance claims and collects outstanding balances.
• Prepare and submit accurate OON claims for residential billing.
• Submits appeals and reconsiderations to insurance companies.
• Makes follow-up calls to insurance companies on accounts with balances.
• Maintains standards to ensure timely collection follow-up.
• Investigates denied claims and updates relevant data in the system.
• Ensures medical records needed for billing are in charts and submitted.
• Reviews payer rejections in a timely manner per standards.
• Identifies claims needing paper submission and manages mailing.
• Monitors provider enrollments to ensure proper claim processing.
• Reviews and amends EOBs and adjusts accounts as needed.
• Communicates potential system/reimbursement issues for efficient reviews.
• Meets billing compliance standards.
• Contacts carriers to reprocess claims per contracts.
• Keeps collection information confidential.
• Participates in continuing education to update knowledge.
• Reviews billing reports and follows up with supervisor.
• Bi-weekly supervision.

Skills

Billing and Coding

Communication skills

Time management

Microsoft Office

Education

High School Diploma or equivalent

Billing and Coding Certification

CRMS/CCA/CCS credentials

Tools

EHR Software

Billing software

Microsoft Office

Job 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

• 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).
• Customer Service
• Decision Making
• Ethics
• Interpersonal Skills
• Job Knowledge
• Conflict Management
• Organization Skills
• Productivity
• Self Development
• Teamwork

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
• 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.