Job Description

The Billing Specialist II is responsible for organizing work flow to complete the timely and accurate submission of medical and dental claims to Medicaid, Medicare, other third party payors and patients. This position is consistently learning how to better utilize EPIC (NeighborHealth’s practice management software), comply with the various payor requirements and maintain a low backlog of work. The billing specialist III works as part of a team that is committed to NeighborHealth’s mission and recognizes that its work has a direct impact on the cash flow from patient revenue for the organization. This position will support Billing Specialist I may also interface with NeighborHealth staff to help insure patient satisfaction. Responsibilities and Duties: Helps ensure the accuracy and completeness of claims submitted to payors and bills submitted to patients. Maintains backlog of work that is consistent with levels established by PFS Manager, including use of EPIC work queues. Maintains knowledge of medical and dental coding, consistent with third party payor requirements. Reviews remittance advices to identify trends in payment delays or denials. Communicates with Director and other Business Office members about status of work flow and helps ensure work is fairly distributed and that deadlines are being met. Reads and understands third party payor reimbursement regulations and updates and works with PFS Leadership to determine their implementation at NeighborHealth. Generates and submits insurance billing claims based on payor preference as required. Analyzes payment denials for possible re-submission of unpaid claims. Work along NeighborHealth Patient Accounts Leadership with various payors being part of the contact group responsible for updates and information required to assist others in the organization. Communicate with patient any billing issues or concerns. Follow up with patients within 5 business days and update as required. Understand and maintain knowledge of the Sliding Fee Discount Program and be able to make adjustments to billing as required. Promote a sense of “team work” through demonstration of direction and self-motivation and direction. Solve problems independently or knows when to seek consultation. EDUCATION: High School Diploma or equivalent. EXPERIENCE: 2-3 years’ experience in a medical billing/insurance office. Excellent written and oral communication skills. Working knowledge of insurance rules and regulations. Strong organizational skills and effective interpersonal skills. Excellent oral and written communication skills. Proficiency in PC software (i.e database). Knowledge of medical terminology, CPT-4 and ICD-9/10 coding helpful. Ability to solve problems effectively. PREFERRED: 2 or more years in electronic practice management system. EPIC Knowledge. SKILLS/ABILITIES: Understanding of Medical Billing, ICD and CPT coding preferred. Ability to interact with all departments, third party payer representatives, and patients and their families. Pays close attention to detail. Demonstrates computer literacy, organization, and a professional attitude.

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