Billing Specialist II

Improving Lives. Improving Communities.

LRADAC offers a wide array of prevention, intervention and treatment programs in both Lexington and Richland counties, so when you join our team, you are truly improving lives and improving communities. As a part of our dedicated staff, you will be a part of innovative programs and services taking a proactive approach to fighting addiction and drug misuse in our schools, businesses, and neighborhoods. We tailor our programs to meet the ever-changing needs of the communities we serve. Our prevention, intervention and treatment programs spread the message that there is hope and that substance misuse and addiction are preventable and treatable.

Under limited supervision of the Director of Patient Accounts, the Billing Specialist II conducts professional-level support in supporting claims examining, claims adjustment, patient accounts, authorization, and other revenue cycle management activities. Work involves both recurring duties and new assignments. May provide assistance to entry-level staff.

POSITION LOGISTICS

• 37.5 hour work week (5-day work week)
• Routinely 8:00 am - 5:00 pm Monday through Friday. Flex schedule considered with supervisor approval
• Consideration is given for hybrid work arrangements with supervisor approval.

POSITION OVERVIEW

Reports to work when scheduled and on time.

Third Party Insurance Responsibilities (55%):

• Responsible for accurately and efficiently processing and submitting claims to insurance companies including appropriate application of modifiers/occurrence codes.
• Handles complex issues related to claims.
• Assist with training staff as needed.
• Monitor and resolve Medicaid edit correction and address claim denials.
• Immediately resolve claim rejections by ensuring benefit, COB and billing information are accurate.
• Ensure that payment and billing information is accurate.
• Research denials and submit corrected claims timely.
• Post insurance payments to patient system and apply the appropriate claim action for remaining balances.
• Acts as contact for patients concerning third party reimbursement.
• Process contractual adjustments.
• Track and monitor unpaid claims by generating weekly insurance aging reports.
• Complete follow-up and contact third party payers regarding unpaid claims in a timely manner.
• Investigates denials and complete claim appeals as necessary.
• Alert the Prior Authorization of any denied claims due to prior authorization issues.
• Process record requests submitted by insurance companies.
• Process paybacks to insurance companies within two business days of request or submit an appeal for recoupment requests.
• Generate and monitors write off reports on a bi-weekly basis.
• Process paybacks to insurance companies within two business days of request.
• Monitors write off reports on a bi-weekly basis.
• Ensuring compliance with healthcare regulations, including HIPPA.

Failed Claims Management (25%):

• Monitor/research failed claims & failed activities.
• Communicate timely to ensure payer issues get corrected.
• Communicate to clinical staff as needed to correct documentation to ensure timely claim submission.
• Escalate payer issues to the Patient Accounts Director as needed.

Patient Account Services (15%):

• Post patient payments and adjustments to patient system.
• Backup for other Patient Accounts staff as needed for both sites.
• Assist patients with questions or concerns regarding their account.

Marginal Duties (5%)

• Attends all required meetings and training sessions.
• Other duties as assigned.

This job has no supervisory responsibilities.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• A high school diploma or GED and 5 years of related experience OR an Associate's degree with 3 years of related experience OR a Bachelor's degree and 2 years of related experience is required.
• Related experience includes: medical billing, claims management, Medicaid, non-profit billing, behavioral health billing, and/or revenue cycle management.
• Experience utilizing an Electronic Health Records (EHR) system is preferred.
• Proficiency in Excel to include reporting and tracking is preferred.
• Knowledgeable in compliance and regulatory requirements related to HIPAA is highly preferred.

• Certified Coding Associate (CCA), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) highly preferred

Please complete the online application to include all current and previous employment history and education. A resume cannot be substituted for completing the employment history and educational fields of the employment application. Incomplete applications will not be considered.

*LRADAC maintains a tobacco-free environment. No smoking or use of any tobacco product is permitted in any of its facilities or on any of its properties.**

Job is regularly Monday - Friday 8:30 am - 5:00 pm. Flex schedule available upon approval from supervisor. Consideration may be given for hybrid work arrangements based on supervisor approval.