As a member of the Finance team, the Billing Specialist will be accountable for assigned claim balances. The role includes obtaining payor authorizations, ensuring proper claim and modifier coding, communicating with clinical staff and insurance companies to resolve issues, resubmitting and adjudicating denied or rejected claims, and applying payments within the electronic health record system and web-based clearinghouse.
This position reports directly to the Contracts and Billing Supervisor.
Essential Job Functions
- Process timely and accurate authorizations for patient services.
- Ensure claims are processed accurately and with correct data points.
- Support identification of issues and implementation of corrective actions and process improvements.
- Manage accounts receivable aging to ensure outstanding balances are resolved in a timely manner.
- Identify the basis for denied claims, communicate corrective actions, and resubmit claims when appropriate.
- Apply payments to client accounts in a timely manner and adhere to month-end cutoffs.
- Develop client statements and communicate client balances upon clinician request.
- Complete billing audits as required.
- Participate in ad hoc projects related to billings, collections, or denials.
- Participate in billing and intake-related meetings and provide input related to billings and authorizations.
Work Location
- This position has the potential to work remotely after the initial 90 days and upon supervisor approval.
Requirements & Qualifications
- Coding certification
- Experience with electronic health record systems
- Knowledge of billing clearinghouses
- Experience calling or electronically inquiring with insurance companies to assess claim status
- Knowledge of diagnosis codes, billing codes, and modifiers
- Experience with accounts receivable aging
Knowledge, Skills, and Abilities
- Advanced knowledge of coding, modifier usage, and denial reason codes
- Proficiency in Microsoft Office applications, especially Excel
- Proficiency with web-based insurance portals and billing clearinghouses
- Proficiency with electronic health systems
- Strong verbal and written communication skills
- Strong organizational skills and attention to detail
- Ability to maintain confidentiality of sensitive information and documents
- Ability to prioritize responsibilities and complete work in a timely manner
Other Requirements
- DHS background check approval
- Successful completion of drug test upon hire
- Documentation of tuberculin test and/or evaluation with negative results or evidence of non-communicability
Location
Portland, Oregon, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
1 month ago