Insurance Billing Specialist - Houston, TX

Cenikor Foundation; Houston (TX); On-site; USD 42,000 - 54,000; Full time

Job summary

Cenikor Foundation in Houston, TX seeks an Insurance Billing Specialist to handle communications with payors, prepare and submit claims, and resolve denials. This role supports admissions,accounts and financial responsibilities across Cenikor’s corporate office.

The position requires 1–3 years in insurance billing, strong Microsoft Office skills, and a focus on accuracy and teamwork within a nonprofit health care environment.

Qualifications

• High School Diploma or GED required.
• One to three years insurance billing experience required.
• Medical billing and coding certification preferred.

Responsibilities

• Prepare and submit clean claims to various Third Party Payors electronically and/or paper submission.
• Interact with insurance carriers to determine coverage and patient responsibilities.
• Follow guidelines for filing and appealing claims for Third Party Payors including Medicaid/Medicare.
• Input data accurately and maintain documentation in client files, invoices and payments.
• Communicate with clients regarding balances, payments and scheduling as needed.
• Assist in setup of payment plans and coordinate with Business Manager and Accounting Assistant.
• Review EOBs and remittances and post entries; analyze and appeal denials as needed.
• Maintain confidentiality of client and foundation information; work with team to ensure accuracy.

Skills

Insurance billing

Administrative procedures

Microsoft Office

Ten-key

Organization

Attention to detail

Teamwork

Communication skills

Outlook calendar

Education

High School Diploma or GED

Medical billing and coding certification preferred

Job description

Insurance Billing Specialist - Houston, TX

Cenikor is a non-profit organization and one of the largest substance abuse treatment centers in the nation. We are currently seeking a Insurance Billing Specialist for our Corporate office in the Memorial area of Houston, TX.

Cenikor's Value Proposition - What's In It for You?:

• PURPOSE in your work - service to others, giving back to your community, helping to save lives, being fulfilled at work.
• COMPETITIVE PAY, BENEFITS, PAID TIME OFF, $2k - $4k TUITION REIMBURSEMENT, up to 10% 401K and BONUSES - we hire and reward high performers.
• STABILITY and GROWTH - more than 55 years in business - our strong financial processes support our drive to serve more people and ensure stability for our team members.
• CONTINUOUS LEARNING and PROFESSIONAL DEVELOPMENT - we are committed to developing our leaders in their desired career path and promoting from within. We have Cenikor Career Pathways Program that you can join after 90 days of employment. We also have an annual leadership development program with assigned mentors to help you achieve your professional goals.
• The work we do isn't easy. If you like to work hard, to serve others and to have FUN with your team while achieving goals, Cenikor will be the right place for you!

JOB SUMMARY:
The Insurance Billing Specialist is responsible for communication with carriers, payors, clients, facilities and
management at all levels to get maximum payment on accounts. Identify and resolve issues or changes to achieve client profitability, as well as complete resolution on denials.

SCHEDULE: Monday - Friday: 8-2pm

ESSENTIAL FUNCTIONS:

• Responsible for knowing and following assigned plans' guidelines, pre-certification requirements and procedures for filing and appealing claims of Third Party Payors, including Medicaid, Medicare, and Insurance.
• Interact regularly with insurance carriers to provide accurate information, allowing the carrier to make an informed determination of a patient's coverage, eligibility, and calculate any patient financial responsibilities.
• Ensure insurance coverage via telephone or web resolves any issues with coverage and escalates complex issues to a supervisor or manager.
• Provide effective communication to client/family, team members and other health care staff in regards to benefits, appointment scheduling, client responsibility via email or other means; provide proper forms for financial responsibility, self pay clients, payments arrangements and admissions payments.
• Work closely and communicate effectively with access center team to ensure all persons interested in admission to Cenikor are contacted within required timeframe and admissions are completed as appropriate. Complete any required documentation and report for access center.
• Assist in all functions associated with Admissions including collecting client responsibility and coordinating with Business Manager and Accounting Assistant.
• Prepare and submit clean claims to various Third Party Payors electronically and/or paper submission.
• Ensure standard codes are accurately assigned to clients' medical information for insurance reimbursement purposes.
• Perform various inquiries and collection actions regarding reimbursements/payments from Third Party Payors by phone or web.
• Answer phone calls from clients regarding accounts and contact clients regarding outstanding account balances for services.
• Assist in setup of payment plans if the client cannot pay in full at the time the bill is received.
• Accurately input data and maintain documentation in client files, including any invoices and payments.
• Analyze, work, and appeal denials from EOB's and correspondence daily. Flag accounts appropriately.
• Review EOB's and download all electronic remittances and ensure that allowances, adjustments, unallocated payments and overpayments are posted correctly.
• Initiate and work up refund requests for overpayments.
• Uphold the core principles of Cenikor's culture and create a positive working environment for all team members.
• Maintain strict confidentiality on all client and foundation matters and refer questionable issues to supervisor.
• Perform additional duties as assigned and consistent with the non-exempt functions as defined in this job description.

QUALIFICATIONS FOR THE POSITION:
Skills, Knowledge and Abilities:

• Skilled in insurance billing coding and processing.
• Skilled in administrative and clerical procedures.
• Skilled in Microsoft Office and ten-key.
• Ability to possess excellent organization and communication skills.
• Ability to be detail oriented and accurately record numerical data.
• Ability to possess a "can-do" attitude.
• Ability to work in a team environment.
• Knowledge of Microsoft Office software required, including specific MS Outlook calendar experience.
• Ability to consistently uphold the Core Principles of Cenikor's Culture:
• Demonstrate mission of service to our clients
• Positive, respectful communication with both staff and clients
• Demonstrate self-motivation and perseverance to achieve goals
• Role model appropriate, professional behaviors including appropriate client boundaries
• Work effectively as part of a team, helping to set up others for success

Education:

• High School Diploma or GED required

Experience:

• One to three years insurance billing experience required.

Certification Required:

• Medical billing and coding certification preferred.