Insurance Billing Specialist and Administrative Support

POSITION : Insurance Billing Specialist and Administrative Support

REPORTS TO (title) : Practice Manager

EFFECTIVE DATE : JOB SUMMARY :

JOB SUMMARY :

Responsible for RCM (Revenue Cycle Management) with psychiatric mental health outpatient clinic

managing billing process in house

• Responsible for maintaining insurance contracts and credentialling
• Accurately manages insurance claims, as well as payment collection with insurance carriers,

intermediaries, and patients.

Provides support for clinical and administrative staff with patient flow to ensure a positive patient

experience.

Assist with administrative duties, as assigned

SUPERVISORY RESPONSIBILITIES :

None

DUTIES / RESPONSIBILTIES :

Mental Health Coding and Billing

i. Revenue Cycle Management (RCM) for Psychiatric mental health E / M, add on therapy

services, behavioral health coding, and insurance reimbursement, denial management and

other aspects of RCM preferred.

1. Electronic billing claims via EHR (Charm EHR and Optum EDI experience a plus)

• Responsible for clean, accurate, and timely claims.
• Claim Management : Manage Outstanding Claims with denials and rejections to

recover claims.

2. Accounts Receivable Management

ii. Experience with various insurance plans to include

1. Governmental plans : Medicare, Medicaid, Tricare

2. Marketplace plans

3. Private / Commercial Insurance plans

4. Self-pay or other insurance payment options

2. Staff and Patient Interaction :

a. Work directly and indirectly with patients, staff, and students for optimal patient experience with

the flow for the patient visit.

i. Support Admin and Provider staff with coverage of front desk and back desk, as needed.

ii. Support growth and development of clinic.

3. Knowledge of :

a. Various Insurance plans (Governmental, Commercial, Exchange, and others) related to

i. Determination of benefits

ii. Eligibility

iii. COB

iv. Timeliness Rules and Guidelines

v. Denials

vi. Prior Authorization for Services and Prescriptions

b. Credentialing Process for all insurance types

i. CAQH

ii. PECCOS (NPI 1 and 2)

iii. Insurance Onboarding and Off-Boarding

iv. Periodic Revalidation with insurance carriers

c. E / M coding psychiatric mental health, therapy add on codes, modifiers, and tele-visits.

i. Familiarity with eClaims using Form 1500 Format

ii. Accurately verifies claim information before submission

1. Appropriate CPT codes with charges, appropriate modifiers, supporting ICD-10

coding with proper positioning, POS,

2. Primary, secondary and other insurance carriers

3. Correct demographics and other details

d. Payment application and Reconciliation :

i. EFT, Checks, or Patient payments applied to outstanding invoices in EHR.

ii. ERA and EOB reconciliation

iii. Claim management with denials, rejections, and reconciliation.

iv. Accounts Receivable management

v. Answers billing inquiries from patients, staff, providers, and insurance companies

e. Periodic Reporting :

i. Reconciliation at End of Day

ii. Month End reporting

Performs other related duties as assigned.

REQUIRED SKILLS / ABILITIES : :

f. Motivated, eager to learn, and grow within a position.

g. Positive, Effective, and clear communication skills (written and verbal)

h. Ability to self-organize, prioritize, and manage time

i. Ability to maintain strict confidentiality (HIPAA) with strong boundaries for patients.

j. Knowledge of basic medical terminology, common acronyms, and insurance jargon.

k. Proficient with the use of computers and web-based technology

l. Proficient with bookkeeping and reconciliation

m. Knowledge of generally accepted accounting principles (GAAP) preferred

n. Possess analytical reasoning and abilities to figure out complex insurance or accounting situations.

4. Experience with :

a. Communication Skills / Experience / Customer Service (at least 2 years required)

EDUCATION AND EXPERIENCE :

High School Graduate or GED, and college or vocational training preferred, but not required.

Communication Skills / Experience / Customer Service (at least 2 years required)

Mental Health Coding and Billing Experience (at least 1 year preferred)