Billing Specialist I/II

The salary range for this position starts at $22-$26/hour depending on experience level (see below).

Seward, Alaska is a small, picturesque town located 120 miles south of Anchorage and is surrounded by beautiful snow-capped mountains in the center of Kenai Fjords National Park. Seward offers year-round opportunities for outdoor activities including skiing, kayaking, fishing, hiking, biking, boating, wildlife viewing, and so much more. Seward Community Health Center (SCHC), a federally qualified health center, is the leading provider of healthcare services in the Eastern Kenai Peninsula. We welcome anyone in need of quality, affordable healthcare by providing integrated, patient-centered primary care for the entire family. SCHC staff are passionate and dedicated to help increase access to services for our community members.

Check out the following link for more information about living and working in Seward: www.sewardhealthcenter.org/careers

About Seward Community Health Center:

SCHC is a federally qualified health center. We welcome anyone in need of quality, affordable healthcare by providing integrated, patient-centered primary care for a variety of illnesses and conditions for the entire family. SCHC is the leading provider of healthcare services in the Eastern Kenai Peninsula, with passionate, dedicated staff who work daily to help increase access to services for our community members. We are seeking to hire additional staff who will add to our ability to make our community and SCHC a better place to live and work.

Benefits Summary:

• Health insurance with medical, dental, and vision benefits for staff and spouse/dependents
• Short- and long-term disability insurance paid by employer
• Term life insurance paid by employer
• 3% employer contribution to a 401(k) retirement plan
• 80 hours of paid holidays annually
• 4 weeks of paid time off annually

Job Purpose

Under the direction of the Revenue Cycle Manager, Billing Specialists are responsible for ensuring timely reimbursement from various third-party payors and patients, managing accurate account documentation in the billing system, and pursuing efficient follow up efforts on aged accounts while maintaining excellent customer service. In addition, Billing Specialists have a working knowledge and are responsible for providing support to the entire front desk and registration process.

The following examples of duties and accountabilities illustrate the general range of tasks assigned to the position at each level but are not intended to define the limits of the required duties. Other essential duties may be assigned consistent with the general scope of the position.

• Documents billing activity on the patient account and submit claims to payors timely.
• Process incoming payments from patients and third-party payors (received both by mail and electronically) and post the payments; daily reconciliation of bank statements with payments posted to ensure that all money received was appropriately posted, and vice versa.
• Reviews, evaluates, and forwards manual patient account statements to payors that do not accept electronic claims or that require special handling.
• Negotiates payment from patients and helps them set up an agreeable payment plan and/or refers them for screening to determine eligibility for financial assistance.
• Manages patient account balances appropriately to include pre-collections, old balances, and same-day service balances.
• Clearly explains service charges to patients, reports any charge/payment errors to billing staff, and resolves any errors within the computer system.
• Answers patient and third-party questions and/or addresses billing concerns in a timely and professional manner.
• Resolves assigned claim rejections and denials; Reports trends and issues findings to the Revenue Cycle Manager.
• Facilitates continuous improvement of operational efficiency by providing supervisor with improvement recommendations and observed trends and issues.
• Adheres to all HIPAA guidelines and regulations
• Assists with training of new Billing Specialists and Registration Specialists, as assigned.
• Responsible for providing routine support to the entire front desk and registration process. See Registration Specialist job description for specific Registration & Front Desk required duties in addition to the Billing Specialist I-II responsibilities.

• Reviews posted payments to ensure accuracy; analyzes explanation of benefits to ensure proper reimbursements.
• Maintains superior understanding of claims management, third-party payor guidelines, state and federal regulations, and all other functions of the job.
• Ensures compliance with all applicable billing regulations and reports any suspected compliance issues to department leaders.
• Reviews and/or resolves credit balances including and submitting adjustments and refunds, as necessary.
• Pursues prompt follow-up efforts on aged accounts, which may involve formulating written appeals.
• Facilitates continuous improvement of operational efficiency by providing supervisor with improvement recommendations and observed trends and issues.
• Create process workflows
• Communicates directly with payors to follow up on outstanding claims and resolve payment variances, responds to payor inquiries, and concerns, and works to develop and maintain positive relationship with payors.
• Assumes responsibility for training of new Billing Specialists and Registration Specialists, as assigned.

Additional Duties and Responsibilities – Level III

• Monitors and reviews denial reason codes and underpayments to identify root causes; works with payor contracting and other areas of the revenue cycle, if necessary, to resolve issues.
• Handle complex billing-related escalations
• Submit and Implement EHR / billing software corrections, updates, and improvements
• Assist with financial reporting and revenue analysis, as needed
• Identifies and analyzes underpayments to determine the reasons for discrepancies and processes denials and appeals; examines claims to ensure payors are complying with contractual agreements.
• Analyzes data to track collection efforts, identify trends, and provide team with updates and ideas for improvement.
• Collaborates with other departments to identify best-practice collections strategies, align goals, and improve collections.
• Assists Revenue Cycle Manager in hiring and training new staff, develops training materials, and provides ongoing instruction to staff as needed.

• High School graduate or equivalent required. College degree or Front office Medical Assistant/Office Specialist certificate from an accredited Medical Technical School preferred.
• Experience with medical billing, to include Medicaid, Medicare, and private insurance preferred.

Education & Experience Level 1 (Salary - Grade 4-5):

• Minimum of one year of experience in professional billing preferred.

Education & Experience Level II (Salary - Grade 5-6):

• Minimum of one year of experience in professional billing including insurance payment posting, denial follow up and in-depth appeals processes required. Certified Billing & Coding Specialist (CBCS) preferred.

Other (all levels):

• Pre-employment drug screening, TB test, required vaccinations per policy, background check and reference check required.

**Years of experience do not necessarily guarantee advancement in levels.

Skills & Performance Goals/Expectations (All Levels):

• Excellent Communicator and Team Player: Demonstrates exceptional verbal and written communication skills. Able to build strong, collaborative, and cooperative working relationships with all co-workers.
• Customer Service-orientated: Must have/develop excellent customer service, interpersonal and organizational skills and possess a positive attitude and demeanor both in person and over the phone with all patients, staff, and visitors. Must be able to stay calm and problem-solve effectively when dealing with difficult interactions.
• Computer and Tech Savvy: Demonstrates computer skills with accuracy and proficiency in data entry, Microsoft Suite, EHR systems, and keyboarding skills.
• Flexible and Motivated: Confidently able to handle multiple tasks while remaining flexible enough to switch directions as needed and ensuring completion with minimal supervision.
• Attention-to-Detail: Must have exceptional attention to detail and a strong sense of prioritization.
• Quality Improvement/Mission Focused: Aligned with SCHC’s values to be collaborative, equitable, trustworthy, patient-centered, and adaptable. Demonstrates knowledge of the organization’s policies and procedures, strategic plan, and stays current on offered programs and services to best serve patients and community. Committed to quality improvement in all aspects of work performance.

Note: As a recipient of federal funding, Seward Community Health Center (SCHC) requires all staff working on-site to be vaccinated against COVID-19. Medical and religious exemptions may be granted according to SCHC policy.

SCHC is an equal opportunity employer.