Job Description

The Medical Billing Specialist will act as the contact between third party billing company, BillCare, and Jewish Family Services (JFS) to support the activities related to medical billing, clinical collections and clinical credentialing. This position works in tandem with the Accounting Department, Clinical Services Department, and front reception desk. The responsibilities include but are not limited to billing and collections, insurance and eligibility verification, acquisition and maintenance of required authorization(s), cross-departmental billing responsibilities, client record maintenance and review, and exceptional customer service and communication skills to agency clients and BillCare. Reports directly to the Director of Clinical Services..

Duties and Responsibilities : 

Clinical Billing 

• Review and address issues in Time Cue in Procentive daily 
• Respond to tickets sent from BillCare within 24-48 hours to ensure issues are resolved and claims are processed timely. 
• In cooperation with BillCare, submit appeals or redeterminations according to payer’s requirements. 
• Communicate with clients to obtain additional information needed due to denials or processing errors based on tickets received from BillCare. 
• Inform Controller and Director of Clinical Services of observed billing issues with specific payers or staff 
• Work with Clinical Assistant to support appropriate billing and coding of prescriber services 

Clinical Collections 

• Support Billcare with submission of appeals, reconsiderations, or redeterminations according to payers’ requirements. 
• Check “Collections” module in Procentive and follow up on outstanding claims. 
• Obtain and maintain reimbursement policies from payers by accessing appropriate payer resources. 
• Communicate with clients in regard to billing issues or overdue balances. 
• Communicate with clinicians billing concerns and errors that occur on front end 
• Process and mail patient statements on a monthly basis. 
• Complete necessary write-off forms with appropriate supporting documentation and submit for approval, based on Accounting guidelines, to the Director of Accounting to assist BillCare in the collections process. 

Comprehensive Community Services and Wraparound Billing 

• Claim pre-approved CCS services weekly through bill submission in Provider Connect and Wrap services monthly through bill submission in Synthesis 
• Email accounting and program staff determinations and expected payments for each bill 
• Communicate timely the truant dates of services needing PConn entry to clinical staff 
• Provide consultation to CCS and Wrap admin staff regarding denial and other revenue issues observed 

Clinical Credentialing Support 

• Serve as primary credentialing specialist and seeking back-up support, as needed. 
• Assist in maintaining a roster of clinicians and their relevant assignments with insurance companies, including but not limited to: tracking of re-validation dates, application for new providers, etc. 
• Assist in ensuring all clinicians are on the appropriate insurance panels consistent with their licensure. 
• Assist in maintaining the CAQH profile for each clinician. 
• Assist with communications and responses to inquiries related to clinicians and/or the organization. 

Insurance and Eligibility Verification 

• Add insurance information gathered during intake process into Procentive. Communicate any discrepancies to CSC for clarification from new client 
• Verify the eligibility on record with the portals for the insurance on file 
• Assist with corrections of insurance information as necessary as to not affect billing and claims processing. 
• Maintain required billing records and client insurance information according to Medicare, Medicaid, Commercial Insurance and EAP guidelines. 

Authorizations 

• Review insurance authorizations obtained and entered and assist as necessary to obtain missing authorizations. 
• Assist in maintaining a system of tracking authorized visits to accurately alert clinicians when new authorizations are necessary. 
• Track EAP sessions, maintain necessary paperwork, and bill accordingly. 

Front Desk 

• Provide reception desk coverage as needed. Duties include: 

Answering and transferring incoming phone calls; 

Scheduling client appointments; 

Collecting client co-pays; and 

Support Case Management and SSRS departments with cash collections or disbursements.

General

• Must have a valid driver’s license, access to reliable vehicle, and automobile insurance coverage throughout employment.
• Knowledge, understanding, and/or willingness to learn Jewish culture and traditions and those of the Agency population as necessary.
• Accept other duties and responsibilities as assigned.
• Candidates must successfully pass a criminal background check with the Wisconsin Department of Justice and a caregiver background check with the Wisconsin Department of Health Services, the Department of Children and Families and the Department Safety and Professional Services. 
• Candidates must pass a Dru Sjodin National Sex Offender and Wisconsin Sex Offender Registry screening.

• High School diploma with at least 10 years of prior medical billing insurance experience, required. Must have previous experience in insurance billing, prior authorization and verification. Being a Certified Medical Biller is highly desired, but not necessary. 
• Comprehensive knowledge of Medicaid programs, including eligibility criteria, covered services, billing rules, recipient rights and provider responsibilities 
• Proficient in Microsoft Office application suite with demonstrated skill in Excel and Word, required. 
• Previous experience with Electronic Health Records preferred. Previous experience with Procentive helpful. 
• Other desired qualities include: highly organized, attention to detail, flexible, self-directed, ability to prioritize work, ability to support a large staff and excellent communication, written and oral, and interpersonal skills. 
• Ability to work effectively with clients, consultants, department/agency staff and others within team concept necessary. 
• Ability to maintain client confidentiality at all times. 

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