Billing and Collection Specialist

* This is a hybrid position providing several days of on-site coverage at our administrative office in Countryside, IL. **

SUMMARY

The Client Financial Services (CFS) Specialist is primarily responsible for Insurance and Client account follow up, billing, collection, and resolution of insurance reimbursement, as well as minimizing loss prevention of the Accounts Receivable.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

• Accounts Receivable – the Pursuit of any unresolved Medicaid, Managed Medicaid, Medicare, Commercial and Crisis claims. Works with CFS team members and provider representatives to prepare supporting documentation for appeals and disputes.
• Focuses on collection and reconciliation of insurance reimbursements, as well as minimizing loss prevention of the Accounts Receivable.
• Manages patient/client collections and payment plans.
• Initiates claim status inquiries to insurance companies, clients, and clinical staff for the purpose of final resolution of claims.
• Initiates inquiries regarding insurance coverage and authorization issues to Commercial and Medicaid entities to help resolve any coverage and authorization denials.
• Focuses on insurance explanation of benefits (EOB) differences and insurance reimbursement.
• Maintain the accuracy of Client Fees for the managed care and commercial client population in conjunction with insurance reimbursement and EOBs
• Processes and Posts insurance payments, review, and resolution of contractual reimbursement
• Troubleshooting Billing issues (eligibility, patient responsibility, contractual reimbursement, etc.)
• Phone calls / online checks to various payers to check status and/or eligibility and benefits.
• Obtain and follow-up on precertification for the clinical staff for treatment, which included processing authorization requests for all Payers (ex. Medicaid, Managed Medicaid, Commercial payers) to ensure future reimbursement.
• Monitoring CPT/HCPCS code changes
• Data Entry of claims, payments, authorizations, coverage, and client fees into agency database
• Answers and troubleshoots client questions from in-bound patient Billing issues – identifies and resolves patient billing complaints.
• Participate in regularly scheduled billing team and CFS department meetings.
• General office tasks as needed.
• Other duties as assigned.

QUALIFICATIONS: 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and or ability required. Reasonable accommodations may be made to enable an individual with a disability to perform the essential duties and responsibilities.

EDUCATION AND EXPERIENCE

High School Diploma or General Equivalency Diploma (GED). Experience with Medical or behavioral health billing required.  Collections experience required. Experience with Medicaid, Managed Medicaid, and Medicare billing preferred. Preference with EClinical Works or Carelogic preferred. Experience with Microsoft Office required.  Must have excellent organizational and planning skills as well as strong communication and decision-making skills.  Must be able to manage multiple tasks and priorities in a fast-paced environment.

LANGUAGE SKILLS:

Bilingual (English/Spanish) preferred.