Job Description

Job Description

Description :

The Medical Billing position is responsible for complete insurance contracting and credentialing processes, as well as process billing and payment on claims for clinic and program services in a timely and accurate manner; monitor and follow up, as necessary.

Essential Responsibilities :

• Maintain working knowledge of enrollment and billing policies, guidelines, and updates for OPWDD-regulated programs and services, and third-party insurers.
• Engage third-party insurers to develop, maintain, and revise contracts for the agency and / or individual providers.
• Negotiate rates with third-party insurers.
• Complete single-case agreements with third-party payments as needed.
• Oversee proper collection of insurance prior-authorizations.
• Oversee accurate client insurance plan coverage and payment responsibility, including notification to client.
• Complete payor credentialing related functions (i.e., enrollment in Medicaid, Medicare, third party insurers) for licensed providers.
• Collect and oversee renewal / recertification of providers licenses / certifications.
• Manage providers malpractice / liability insurance coverage through the agency.
• Coordinate with providers to complete / update CAQH profiles and credentialing paperwork in a timely and efficient manner.
• Maintain Kelberman ETIN certifications for relevant programs and individual providers.
• Maintain working knowledge of CPT and ICD-9 coding principles, governmental and state regulations, protocols and third-party requirements regarding coding and billing documentation.
• Accurately submit / oversee submission of billing claims to Medicaid, Medicare, and third-party insurers.
• Responsible for researching unpaid claims to discern issues related to non-payment, (coverage limitations, billing, coding, or demographic errors)
• Contact Medicaid, Medicare, third-party payers, and clients to take appropriate corrective actions to secure payment on those claims.
• Perform other duties as assigned.

Work Environment and Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising workflow and efficiency.

Supervised by : Chief Financial Officer

Supervisory Responsibilities : This Job has no supervisory responsibilities.

The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required for the position. This job description may be changed at any time and does not constitute a contract or agreement.

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

Requirements :

Medical billing / coding certificate and 1-2 years of experience in healthcare billing or equivalent combination required.