Human Services Billing Specialist

Job Summary :

The DHS Billing Specialist performs functions required to process health insurance claims, monthly client statements and maintain accounts receivable for services provided in the Human Services Department, relating to Outpatient Behavioral Health programs, Birth-To-Three program, and Room & Board / Residential Treatment / Inpatient Hospital. The DHS Billing Specialist works with clients to set up payment plans when necessary, and monitors compliance with payment plans that are in place. The DHS Billing Specialist works with the DHS Billing Coordinator, the Office Services Manager and reception staff to recoup funds through the Sate Debt Collection program when other options are exhausted. This is a non-exempt position.

Essential Functions and Responsibilities :

The following duties are primarily performed and are essential for this position. Employees are expected to be able to perform each of these job duties satisfactorily and successfully with or without reasonable accommodations to be qualified for the position. Other duties may be required and assigned.

50% Accounts Receivable Management :

• Records client and Third-Party payments in the electronic health record (EHR) database.
• Reviews insurance payments entered in the EHR database by other DHS staff for accurate payment application.
• Reviews insurance payments imported from clearinghouse - reviews each client on remittances and initials corrections if necessary.
• Identify deductibles / coinsurance / copayments, roll-down balance to next payer or client.
• Investigate and resolve denied claims using clearinghouse, contacting the payer, or by making corrections through the clearinghouse or insurance company's web portal using the knowledge of DHS and insurance company / government regulations.
• Reviews unapplied payments made by insurance companies and clients determine if a refund is due.
• Follows-up on outstanding insurance invoices by coordinating with insurance companies.
• Prepares collection forms for past due client balances according to county ordinance and give to program manager for approval. Work with staff to ensure collection referral warning letters are sent, and that collections are entered into the State Debt Collection system if no action is taken by the client.

30% Bill for Provided Services :

15% Supportive Duties :

5% Other Duties as Assigned :

Supervision Exercised :

Trains reception staff on Insurance Eligibility processes.

Monitor reception staff for fiscal compliance when obtaining up-to-date insurance, demographics, appropriate financial documentation and general client file maintenance.

Minimum Education Qualifications :

Education and / or Experience Requirements :

Associate's degree or certification in Medical Billing / Coding.

High School Diploma.

Three to five years' healthcare billing experience.

Experience in mental health and substance abuse billing preferred.

Licenses, Certifications and Other Requirements :

None

Minimum Knowledge, Skills and Abilities Qualifications :

In order to perform the functions and responsibilities of the position (listed above) the following knowledge, skills, and abilities are essential.

In evaluating candidates for this position, Ozaukee County may consider a combination of education, training, and experience which provides the necessary knowledge, skills, and abilities to perform the duties of this position.

Physical Requirements :

Work Environment :

Inside office work in a professional office setting.

Shared work environment

EOE / ADA Statement :

Ozaukee County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, Ozaukee County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.

Nothing in this job description limits management's right to assign or reassign duties and responsibilities to this job at any time. The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. The job description does not constitute an employment agreement or affect the at-will nature of the employment arrangement between the employee and company and is subject to change by the employer as the needs of the employer and requirements of the job change.

Ozaukee County offers a generous benefits package including : health, dental, life, & vision insurance; free employee health clinic & Teladoc; paid holidays, vacation, & sick time; state of Wisconsin WRS defined benefit pension program; bonus opportunities; employee fitness room; wellness program & wellness reimbursement; tuition reimbursement & continuing education opportunities; and more! Please note some that benefits offered are dependent on full-time / part-time status.

Ozaukee County prohibits discrimination and harassment of any type against applicants and employees on the basis of race, color, religion, sex, national origin, age, handicap, disability, genetics, veteran status or military service, marital status or sexual orientation, gender identity or expression, or any other characteristic or status protected by federal, state or local laws. Ozaukee County also provides reasonable accommodations to qualified individuals with disabilities in accordance with the requirements of the Americans With Disabilities Act and applicable state and local laws.