Billing and Claims Specialist
Job Type
Full-time
Description


OBJECTIVE:

Assist in the overall daily office and administrative activities to support the Children & Family Services division of Lumibility.


QUALIFICATIONS:

  • High school diploma/GED required
  • Bachelor’s degree in related field preferred
  • Proficiency in Microsoft Office software including Word, Outlook, and Excel
  • Must possess a valid Connecticut driver’s license, have an acceptable driving history and be able to utilize your own vehicle for Lumibility business as defined by Lumibility’s policy
  • Bilingual (Spanish) preferred
  • Experience with medical billing, insurance reimbursement and reconciliation, preferably in a clinical/medical environment required
  • ICD/10 and CPT coding experience required
  • Knowledge of insurance/Medicaid practices required
  • Ability to recognize discrepancies in billing data and investigate the issue to determine resolution
  • Excellent interpersonal skills and phone interactions
  • Must have strong organizational skills and the ability to work in a fast-paced environment
  • Must have internet access, a cell phone, private workspace, and reliable transportation


Hours: 40 hours/week, M-F, Non-Exempt 

Location: Hybrid 

Pay Rate: $24 - $26 per hour




ESSENTIAL JOB FUNCTIONS:

 

  • Input employee and independent contractor billing information into state database accurately and expeditiously to ensure proper records handling and prompt payment responses
  • Initiate internal billing corrections and voids process according to procedure and make corrections in agency and state database
  • Run reconciliation reports to identify data and billing errors, adjudication reports and follow up to make corrections
  • Enter client data from eligibility documents including insurance forms and statements of eligibility into state database
  • Review and identify errors proactively and take necessary action to track and resolve
  • Work collaboratively with the state contacted billing company, opening tickets, investigating and working claims, adjudication, denials, appeals and reimbursement
  • Update job knowledge by participating in training opportunities and keeping current on state contract, insurance billing and reimbursement procedures. Adhere to company standards and federal and state requirements
  • Maintains communication with other departments to promote positive working relationships and open communication
  • Develop processes to address systems (embed resources and procedure changes into office procedures, create a day-to-day task priority list, determine needed changes to current procedures, create checklists for checks and balances and revise as needed)
  • Verify insurance information in state and private insurance company database
  • Enter insurance information in state database
  • Participate in state led Community of Practice meetings and subcommittees, work collaboratively with Business Operations Manager to generate and maintain procedures related to the Billing & Claims position
  • Perform other roles within the office team to provide support as requested
  • Contribute during meetings and training sessions
  • Performs other duties as assigned. 
  • If bilingual, provides interpretation for families during phone conversations and      verifies translated documents as needed. 
Requirements

KNOWLEDGE, SKILLS AND ABILITIES:

  • Knowledge of medical billing and insurance reimbursement
  • Knowledge of medical coding preferred
  • Knowledge of company policies and procedures and applicable regulatory requirements and standards
  • Skill in data entry, analyzing information, documentation and reporting
  • Skill in planning, organizing, attention to detail and work in a fast-paced environment 
  • Skill in problem solving and decision making
  • Skill in operating standard office equipment, computer and various software packages
  • Skill in communicating effectively in a courteous and professional manner
  • Skill in writing clearly and concisely to maintain accurate records 
  • Ability to read and understand policies and regulations and to translate general guidelines into specific action
  • Possess critical thinking skills
  • Ability to demonstrate good communication and interpersonal skills necessary to provide guidance and instruction to families
  • Ability to work successfully, both independently and in a team environment
  • Ability to maintain confidentiality
  • Ability to maintain a patient and positive attitude
  • Ability to drive/travel to varying locations as needed
  • Ability to identify and prioritize daily tasks depending on timelines related to daily workflow
  • Skill in planning, implementation, self-monitoring and organization
  • Skill in effective problem-solving and decision making
  • Ability to stay current with changing technology trends 
  • Ability to work flexible hours and travel as needed

 

Benefits include medical, dental, and vision coverage; life and disability insurance, a 401(k) with employer match, paid time off, wellness benefits and employee assistance programs. We are committed to supporting family-centered practices and providing opportunities for professional growth.  


Lumibility is an Equal Opportunity Employer