Martindale Brightwood Health Center - 2855 N Keystone Avenue, Suite 100, Indianapolis, IN 46218

Fair Labor Standards Act Classification: Non-Exempt

**Position will be working onsite and remotely. 

This position is responsible for reviewing and resolving accounts for assigned payers in order to reduce accounts receivable aging and support timely reimbursement. This position is responsible for all aspects of electronic and paper claim submission, claim correction, insurance follow-up, denial resolution, and account research for Medicare, Medicaid, and Commercial payers. The incumbent is responsible for following proper billing processes, timely follow-up, and resolution of accounts, while identifying and communicating internal issues impacting claim payment or reimbursement. Reports compliance concerns, payer trends, and recurring billing issues identified through daily account review.

Essential Functions

Account Review

· Reviews assigned accounts and third-party payer activity to determine appropriate follow-up actions in order to reduce account aging and support timely reimbursement. · Documents all actions taken and researches claim, billing, denial, and reimbursement issues requiring resolution. · Reviews and resolves billing problems arising from patient care facilities by identifying errors, determining corrective action, and implementing necessary corrections. · Makes recommendations regarding account resolution, workflow concerns, and reimbursement trends to supervisor/director based on daily account review and overall work efforts.

Communication

· Serves as liaison to third-party payers, patients and families, providers, referral sources, and internal staff regarding billing, claim status, denial resolution, and reimbursement-related issues. · Maintains regular communication with payers to obtain claim updates, resolve outstanding balances, and address billing concerns. · Applies appropriate health literacy methods when communicating with patients and clients to ensure understanding of billing and insurance information.

Claims

· Performs electronic and paper claim submission, insurance follow-up, and denial resolution activities with Medicare, Medicaid, and Commercial payers to support accurate reimbursement and reduce account receivable aging. · Reviews claim status, researches payer responses, and takes appropriate action to resolve outstanding claims in accordance with departmental guidelines. · Performs case evaluation activities related to sliding fee scale applications and payer compliance requirements.

Billing

· Applies appropriate billing procedures and payer guidelines for Medicare, Medicaid, Commercial, HMO, and PPO insurance carriers to ensure accurate and compliant claim processing. · Reviews billing for accuracy, completeness, and timely submission within departmental standards. · Utilizes knowledge of payer regulations, billing requirements, and reimbursement guidelines to support proper claim resolution and compliance with Fraud and Abuse prevention initiatives. · Assists with payment posting activities and reconciliation of Medicare, Medicaid, HMO, and PPO payment listings against individual patient accounts as needed.

Information and Follow-Up

· Obtains additional information required by payers to support claim processing, reimbursement, prior authorizations, referrals, certifications, and account resolution. · Responds to billing-related questions and requests from payers, providers, patients, and outside sources in a timely and professional manner. · Contacts patients when necessary to obtain or verify information needed to properly process and resolve claims.

Training

· Completes structured in-house training based on current knowledge, experience, and demonstrated understanding of billing workflows, payer guidelines, claim submission, denial resolution, account follow-up, and departmental processes prior to independent account management. · Participates in ongoing in-house education and workflow review sessions, including bi-monthly meetings with the team lead and quarterly team meetings focused on payer updates, process consistency, training reinforcement, and workflow improvement. · Actively participates in process improvement initiatives, documents issues requiring management follow-up, identifies resources, and assists with problem-solving and resolution of billing-related concerns.

Payment Posting

· Assists with payment posting activities related to paper and electronic insurance payments, ERAs, ACH transactions, mailed patient payments, and applicable contractual adjustments in accordance with payer and managed care contract guidelines. · Ensures payments and adjustments are posted accurately and within departmental timeframes. · Assists with reconciliation of posted payment amounts to deposit totals and performs payment posting functions in accordance with departmental productivity, accuracy, and quality standards.

Unidentified Payments

· Reviews and researches unidentified payments, credit balances, and debit balance discrepancies to determine appropriate resolution and account reconciliation. · Takes appropriate action to identify payment sources, resolve unapplied or misapplied payments, and correct account variances.

· Communicates findings and unresolved issues to leadership as needed and completes required documentation to support reconciliation and resolution activities..

Reporting/Auditing

· Extracts and reviews data to ensure claims are created, submitted, and followed up on timely and that charges are entered accurately and in accordance with billing guidelines. · Participates in required audits and quality review activities to support reimbursement accuracy, compliance, and improved operational outcomes. · Reviews and corrects billing or claim issues identified through internal or external audit findings.

Quality Compliance

· Maintains compliance with applicable policies, procedures, performance and quality standards. · Identifies and communicates opportunities for improvement.

Service Excellence

· Meets expectations of preeminent service, including behavior that models: Service Excellence-Every encounter, every time, no exceptions and no excuses. · Consistently demonstrates excellent communication, quality, professionalism and environment

Connect to Promise

· Demonstrates a commitment to HealthNet’s mission, vision, and values by exhibiting behaviors and delivering results that align with the strategic direction of the organization. · Continuously provides the best individualized care and service to patients, customers, colleagues, business partners, and the communities we serve. · Apply a minimum of one health literacy method when communicating with patients/clients.

HIPAA

· Always maintains the confidentiality of any patient or employee medical, financial, or other personal information, records, and data to which there is access. · Views, uses, or discloses such information only for reasons necessary to perform duties. · Responsible to challenge unauthorized individuals from viewing such confidential patient or employee information or accessing restricted areas.

Commitment to Diversity

· Committed to fostering a diverse, inclusive, and equitable work environment, where all employees, whatever their gender, race, ethnicity, national origin, age, sexual orientation or identity, education, or disability, feels valued and respected. · Committed to a nondiscriminatory approach and provides equal opportunity for employment and advancement in respective departments, programs, and worksites. · Respects and values diverse life experiences and heritages and ensures that all voices are valued and heard. · Committed to modeling diversity and inclusion and to maintaining an inclusive environment with equitable treatment for all.

The preceding essential function statements are not intended to be an exhaustive list of

tasks and functions for this position. Job descriptions provide a representative

summary of the major duties and responsibilities performed by incumbents. Other

tasks and functions may be assigned as needed to fulfill the mission of the

organization.

QUALIFICATIONS/KNOWLEDGE/SKILLS/ABILITIES

· Requires high school diploma or equivalent · Requires prior experience in medical billing, claim follow-up, denial resolution, and third-party payer reimbursement processes with strong knowledge of Medicare, Medicaid, and Commercial payer requirements. · Requires knowledge and proper application of payer policy, reimbursement methodologies, contractual adjustments, allowable amounts, denials, discounts, and payment resolution processes. · Requires basic knowledge of medical terminology, as well as working knowledge of coding concepts including CPT, HCPCA, ICD-10, and UB claim requirements and medical billing practices. · Requires knowledge and use of electronic payer inquiry systems, claim status portals, and insurance research tools for Medicare, Medicaid, Blue Cross, and other Commercial payers. · Requires ability to research and resolve credit balances, debit balances, adjustment claims, and reimbursement discrepancies with Medicare and Medicaid payers. · Requires strong analytical and critical thinking skills with the ability to identify claim issues, payment variances, denial trends, and account discrepancies. · Requires ability to work independently and demonstrate strong self-directed research and problem-solving skills. · Requires ability to manage multiple accounts, priorities, and workflow assignments simultaneously while meeting productivity and quality standards. · Requires ability to adapt to changing workflows, payer requirements, departmental priorities, and shifting responsibilities while maintaining productivity, accuracy, and professionalism in a fast-paced healthcare environment. · Requires knowledge of medical billing systems, electronic claim processing, payment posting, and account resolution workflows. · Requires ability to handle sensitive patient information while maintaining a high degree of confidentiality in accordance with HIPAA standards. · Requires strong organizational, customer service, listening, written, and verbal communication skills. · Requires ability to work efficiently, accurately, and professionally under pressure while exercising appropriate judgment and attention to detail. · Requires the ability to understand operational workflows, departmental objectives, and compliance requirements while following established procedures. · Requires ability to successfully complete annual competency and departmental training requirements. · Travel may be required.

Physical Requirement:

· Prolonged periods of sitting at a desk and working on a computer. · Able to be involved in degrees of prolonged standing, walking, sitting, bending, squatting, and stooping; as well as abilities of repeated bending, stooping, and squatting. · Able to lift, push, and/or pull light to moderately heavy weight up to 20-30 pounds is a necessary function of this position. · Able to perform duties during periods of varied and/or prolonged work hours. · Must be able to read, write, hear, and communicate effectively in the English language by both orally and written.

EVALUATION OF PERFORMANCE

The Billing Specialist will receive annual performance evaluations that rate job performance in accordance with HealthNet vision, mission, policies, and procedures. The evaluations may include, but not be limited to, performance of many of the specific skills and abilities noted above. The Billing Specialist is expected to present an exemplary professional image; maintain a positive attitude toward work and HealthNet; display a willingness to accept and complete assigned job responsibilities and duties; demonstrate the ability to independently exercise judgment, , and complete all phases of assigned tasks or projects; and serve as a positive role model for other HealthNet staff.

EQUAL EMPLOYMENT OPPORTUNITY:

HealthNet is an Equal Employment Opportunity Employer and employment decisions are made without regard to race, color, sex, religion, national origin, age, disability, sexual orientation, or any other c