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Billing Specialist

3 months ago

Grand Rapids, United States North Homes Inc. Full time
Job DescriptionJob DescriptionDescription:

The primary responsibility of the Billing Specialist is to effectively perform all third party insurance and MA billings for all eligible programs of North Homes, Inc. and submit county billings for programs that include both third party insurance and county reimbursements (family services, IJC). Teamwork and positive problem solving skills are to be used in all aspects of the job. Primary duties include processing all Third Party Insurance and MA billings; the preparation of reports that reflect MA and insurance billings and payments and individual MHP and practitioner activity; monitor agency compliance with HIPAA and MHCP regulations for billing; regular and accurate communication with the Billing Supervisor in regard to these functions; and other duties as assigned by the Billing Supervisor.


MA and Third Party Insurance Billings for Outpatient Chemical Dependency, Outpatient Mental Health Services, Day Treatment, CTSS, 35-day Evaluations, and Residential Treatment

  • Develop a thorough knowledge of North Homes, Inc., HIPAA, and MHCP billing and collection policies and procedures.
  • Enforce timelines for North Homes, Inc. staffers to turn in paperwork in order to maximize revenue and provide consistent cash flow for the involved programs
  • Process necessary credentialing paperwork as needed for various insurance companies to allow us to bill insurance claims
  • Maintain the agency billing system to ensure accurate and timely completion of all Third Party Insurance and MA billing.
  • Maintain agency contracts with insurance providers in order to ensure accurate reimbursement for services.
  • Submit County billings for IJC and In-Home County contracts on a monthly basis and as needed.

Facilitate authorization and extension process for CTSS, Day Treatment, and Outpatient Mental Health patients as needed.

  • Continuously and consistently bill Third Party Insurance and MA for Mental Health Services provided by North Homes, Inc. as needed. Communicate any difficulties in gathering information, billing or collection of billed services with the Compliance Director.
  • Provide monthly reports that detail and summarize the following: Individual program billings, individual MHP billings, individual practitioner billing, and accounts receivable.
  • Review accounts receivable report with Compliance Director on an as-needed basis.
  • Participate in meetings with agency and county staff as needed and directed in order to provide agency updates and maximize MA and Third Party Insurance revenue.

Mental Health/In-Home Department Administration

  • Complete re-credentialing paperwork as needed
  • Do termination of employment paperwork to companies when therapists leave
  • Complete various applications/paperwork to attempt to credential al new therapists with insurance companies
  • Follow up with insurance companies that request more info.

Reporting / Billing

  • Ensure that accurate data is reported for Mental Health billing purposes on a timely basis as outlined by Billing Supervisor
  • Confirm the insurance coverage of all Mental Health clients and call third party insurances for approval if required as needed
  • Follow up on people who don’t have insurance but state they do
  • Send the pending sheets that require additional information from the therapist to the Billing Specialist. Send an email at the end of each month to each professional.
  • Contact the client or necessary agency if insurance is not eligible to determine the reason
  • Ensure insurance verifiability and prepare billing sheets for the new system.

Mental Health Coordination

  • Continue the development of a smoother, more efficient method of tracking vital information for billing
  • Ensure billing is submitted appropriately for services provided
  • Follow up with insurance denials – refile to appropriate comp.
  • Do an account review twice a month for charges over 45 days
  • Send out reminder letters and final notice letters for clients with an unpaid balance
  • Send clients to collections if no payment has been made in 4 or more months
  • Send out payment waiver agreements to clients whose insurance has lapsed
Requirements:

Two years experience in mental health services billing, and two years experience in performing administrative assistant functions preferred

Individual must be non-judgmental in regards to lifestyle, race and/or economic status of clients.

Must be 21 years old and have a valid Minnesota Drivers License.