Job Title: Billing & Coding Specialist 

Department: Admin

Reports to: Billing Manager

FLSA Status: Full-Time – Non Exempt -36 hours

Must Live in Oregon 

Our mission is to improve the lives of those struggling with mental health and substance use by providing timely access to compassionate and effective behavioral healthcare. As an organization, we value Authenticity, Integrity, Compassion, and Connection; therefore, in all our interactions we will walk a courageous path where our values, ideals, and actions align to create and maintain authentic connections with others.
 

Position Overview: 

The role of the Billing & Coding Specialist will be to provide necessary services in data analysis to facilitate conformance with billing processes, and to develop and maintain efficient charge capture & claims submission procedures.  

This position is responsible for accurate, detailed and thorough behavioral health billing processes. The Billing & Coding Specialist will work in coordination with other Billing Team members (as well as the Finance Director and Business/Accounting Manager) utilizing billing knowledge to ensure the timely and accurate processing of client accounts. This position requires strong customer service, phone, and computer skills and the ability to interact well with the team as well as understand fully (and adhere to) the best business and administrative practices.  

ESSENTIAL POSITION RESPONSIBILITIES: 

Billing Cycle Coordination 

1. Possess working knowledge of current healthcare reimbursement methodology (i.e. fee schedule, per diem, capitation, etc.). 
2. Enter, maintain, and monitor all pertinent data in the EMR health record and billing software (financial, insurance, billing, claims, adjustments, and payment data). 
3. Monitor electronic claims submission for optimal performance routing any required updates to payer rules and/or EDI transaction to Billing Manager. 
4. Daily coding and claim submission of all clinical charges, includes review of clinical documentation for completeness, selecting correct billing codes, and appending modifiers as needed. 
5. Query providers when there is a documentation or billing issue. Escalate provider non-responsiveness to program director. 
6. Possess working knowledge of managed care health plans & prior authorization requirements. 
7. Work with Billing Manager to maintain the most current insurance contract reimbursement rates within the EMR. 
8. Keep current on billing requirements for enhanced insurance reimbursements and apply necessary coding adjustments. 

Front Office and Clinical Team Coordination 

1. Assist front office staff with eligibility, benefits, and COB (coordination of benefits) verifications and prior authorization requirements for Commercial, Medicaid & Medicare payers. 
2. Develop/present training materials for front office and clinical staff related to client accounts and typical outstanding Accounts Receivable issues. 
3. Develop and maintain good working relationships with front office and clinical staff. 
4. Provide back-up support to Billing Manager with bi-weekly reconciliation of payroll related reports (provider service report, adjustment report). 

Patient Account Management 

1. Provide excellent customer service and professional correspondence. 
2. Exercise good judgment and tact in dealing with clients. 
3. Understand privacy legislation related to healthcare information, (i.e. HIPAA) and follow all HIPAA requirements necessary to maintain patient confidentiality. 
4. Assist in resolving client billing/payment problems or issues in conjunction with other Billing Team members. 
5. Monitor status of denied claims, electronic remits, rejected claims, and patient payments; provide support where needed. 
6. Monitor past due client accounts and work with Billing Team to ensure pre-collection guidelines are being followed.  
7. Maintain support fund spreadsheet (adding new applicants, recording financial support, and notifying stakeholders of new & upcoming expiring financial support.) 
8. Monitor account credit balances and process insurance/patient refunds as needed. 
9. Provide support to patients for enrollment to the Patient Payment Portal. 

Billing Team Coordination 

1. Demonstrate self-direction and strong organizational skills. 
2. Work with the Billing Manger, Finance Director, and Business/Accounting Manager to produce and monitor billing reports, review unpaid/denied claims, and identify contract issues that need resolution. 
3. Think outside the box and pursue alternative solutions. 
4. Demonstrate good communication skills by picking up the phone and following through on open issues. 
5. Exhibit strong written, oral, phone, and computer skills. 
6. Perform other duties as assigned by the Billing Manager, Finance Director, or Business/Accounting Manager. 

What we offer:

• Health insurance – employer pays 100% of base plan premium
• Dental insurance
• Vision insurance
• 401(k) with employer match
• Flexible spending account
• Life insurance
• 10 paid holidays including your birthday
• Paid vacation (PTO accrual)
• Sick leave accrual
• Paid wellness days

Compensation $28-32/hr. depending on experience

QUALIFICATIONS Minimum Qualifications/Requirements:  

Required:

• High school diploma or equivalent.  
• Oregon Medicaid Billing Experience 
• Minimum 2 years of medical billing experience required 
• Strong Knowledge of insurance processes, authorizations, and denials 
• Live in Oregon 

Preferred: 

• Mental behavioral health billing experience strongly preferred 
• Preferred: Certified Medical Billing/Coding (CPC, CCS, CBCS, or equivalent 

Typical Working Conditions: Position is mostly remote (working from home with occasional on-site meetings in Prineville). Requires the ability to exert a small amount of physical effort in sedentary to light work involving moving from one area to another; may require some moderate lifting, bending, reaching, kneeling and some climbing of stairs; sufficient hand/eye coordination to perform semi-skilled repetitive movements such as operating office equipment. The position requires sitting for extended periods of time throughout the day. Work is generally performed in a remote office environment and may include occasional interruptions when required to attend meetings on site. 

Equipment Used: Telephone systems, computer systems, basic hand tools, copier/printer/fax equipment.