24-10 Claims/Billing Specialist (Union)

<strong>Sanilac County CMH embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence.&nbsp;<br /><br />Join our team today!</strong>

Sandusky, MI 48471

Sanilac County Community Mental Health

<p><strong>Sanilac County Community Mental Health Authority (SCCMH) is a CARF accredited public provider of managed mental health and developmental disability services. With St Clair, Genesee and Lapeer counties, SCCMH is a member of Region 10, a 4 county public mental health alliance which provide mental health services to persons eligible for Medicaid benefits under a capitated funding agreement. Sanilac County CMH embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence. An employee in this or any position is expected to support the employment environment. This includes having lived experience with behavioral health issues.<br /><br />See our full list of openings <a href="https://recruiting.ultipro.com/SAN1014SCMHA/JobBoard/a547ade3-b9e2-4664-a826-a65e773c1847/?q=&amp;o=postedDateDesc" target="_blank" rel="noopener noreferrer">here.</a><br /></strong></p> http://www.sanilaccmh.org/

keywords: position summary,assist,support,performance,claims,process,billing,qualifications,knowledge,communication,skills

Full-Time

$18.00/HR-$22.67/HR

Overview: Under the direction of the Admin. Supervisor &ndash; Finance/Billing, and in conjunction with the other Billing and Finance staff, completes duties as assigned in the areas of claims processing, billing and reimbursement.<br /><br /> <p><strong>COMPETENCIES FOR ADMINISTRATIVE STAFF</strong></p> <p>Sanilac CMH staff are dedicated to providing services to the community to improve lives. When they see a task that needs to be completed, they step in to assist or are first in line to help the Agency in promoting recovery, discovery, and independence. Each staff member works within their strengths and collaborates with their coworkers so that collectively we are a stronger whole. Staff provide positive feedback and suggestions to improve the quality of care in the Agency. They hold their coworkers, the individuals they serve and the community in high esteem.</p> <p>To perform the job successfully, an individual should demonstrate the following competencies:</p> <p><strong>&nbsp;</strong></p> <p><strong>Initiative/Organization/Reasoning:</strong></p> <ul> <li>Takes initiative and steps in to take on difficult challenges.</li> <li>Willing to identify problems and work to resolve them in the early stages.</li> <li>Plans and organizes work activities and uses time efficiently.</li> <li>Properly organizes and carries out job tasks in a timely manner.</li> <li>Is a self-starter in attaining job objectives.</li> <li>Know and understands job expectations and is willing to expand job knowledge and skills to be more effective to the Agency and the individuals served.</li> <li>Is enthusiastic about the Agency&rsquo;s Mission and is a positive influence for co-workers and individuals served.</li> <li>Demonstrates an understanding of and adherence to Agency policies and procedures and is willing to provide suggestions to make policies and procedures more efficient.</li> <li>Is willing to think outside of the box while able to make sound decisions and taking actions based on sound reasoning and weighing possible outcomes.</li> </ul> <p>&nbsp;</p> <p><strong>Ethics/Teamwork:</strong></p> <ul> <li>Consistently treats all people with dignity and respect.</li> <li>Demonstrates expected ethics and principals.</li> <li>Accepts responsibility for actions and follows through on commitments.</li> <li>Demonstrates ability and willingness to work cooperatively and effectively as part of a team.</li> <li>Willingly acknowledges team members and co-workers&rsquo; value to your work.</li> </ul> <p><strong>&nbsp;</strong></p> <p><strong>Emotional Intelligence:</strong></p> <ul> <li>Verbal and written communication is constructive, effective, respectful, and clear.</li> <li>Demonstrates the ability to adapt to changes in work situations.</li> <li>Willing to take the time to learn about co-workers&rsquo; personality so that working together is more effective.</li> <li>Willingness to ask questions, listen to others&rsquo; ideas, and understand how the impact of your work, impacts your co-workers/team.</li> <li>Establishes and maintains effective relationships.</li> <li>Willing/Ability to be cost-conscious.</li> <li>Staff are expected to learn and understand job functions and carryout tasks in a proficient manner.</li> </ul>
Responsibilities: <ul> <li>Process all assigned Provider Network claims through the computer system&rsquo;s claim adjudication process within the appropriate guidelines of the Agency and PIHP.&nbsp;Send claim rejections to appropriate providers and follow up as needed. Ensure that Medicaid is payer of last resort. Submit invoices to the Finance staff as appropriate.</li> <li>Communicate and work effectively with Provider Network staff as necessary to facilitate prompt payment. Monitor the timeliness of Provider Network claims payment from receipt to payment. Assist with training to Provider Network staff regarding claim entry into OASIS. Assistance to Provider Network staff regarding claim entry into OASIS.</li> <li>Complete Financial Determinations at intake and annually for all non-Medicaid individuals. Track/monitor ability to pay information for all non-Medicaid individuals. Keep current and up to date on MDHHS ability-to-pay rules.</li> <li>Generate appropriate billing for all assigned 3<sup>rd</sup>&nbsp;party payers, secondary payers and COFR payers for all services, voiding and correcting errors, address and reprocessing rejections, and verifying waterfall through appropriate guidelines of insurance payers. Ensure that Medicaid is payer of last resort. Correspond with staff as necessary on issues arising from payer&rsquo;s rules/regulations.</li> <li>Enter/process all assigned 3<sup>rd</sup>&nbsp;party insurance payments for services provided, no matter the form of the remittance; to appropriate individual accounts in the Agency&rsquo;s electronic medical record (OASIS). Reprocess/address all assigned 3<sup>rd</sup>&nbsp;party payer rejections and rebill all assigned 3<sup>rd</sup>&nbsp;party payers as appropriate and in a timely manner. Generate Open-Line-Item reports monthly for all assigned 3<sup>rd</sup>&nbsp;party payers and address all services from prior billing months appropriately to ensure that all (open) services have been rebilled appropriately within a timely period. Keep reconciled monthly Open-Line-Item reports on file for all 3<sup>rd</sup>&nbsp;party payers.</li> <li>Process all claims through the computer system&rsquo;s claim adjudication process within the appropriate guidelines of the Agency and PIHP.&nbsp;Send claim rejections to appropriate staff and follow up as needed. Submit invoices to the Finance staff as appropriate.</li> <li>Review Medicaid, Medicare, BCBS, and MI Child Bulletins/updates. Knowledge of MDHHS and Medicaid Standards. Maintain integrity and confidentiality of client records and personal health information.</li> <li>Complete monthly, quarterly, and annual reports for the CFO and/or Admin. Supervisor &ndash; Finance/Billing.</li> <li>Attend MARO and other training as appropriate.</li> <li>Assist with eligibility and authorization requests as needed.</li> <li>Assist with Finance/Billing projects.</li> <li>Stay current with and adhere to Agency policies and procedures.</li> <li>Stay current with and follow Agency training and procedures.</li> <li>Perform other duties as assigned.</li> </ul>
Requirements: <p>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 individuals with disabilities to perform the essential functions.</p> <p>&nbsp;</p> <p><strong>EDUCATION and/or EXPERIENCE</strong></p> <p>Bachelor's degree in a related field from four-year College or University preferred. Associate degree or equivalent from a two-year college or technical school in a medical billing/claim adjudication field; or 5 years of experience or training in third party insurance billing/claims adjudication process. Two or more years working in an EMR system preferred. &nbsp;</p> <p>&nbsp;</p> <p><strong>COMPUTER SKILLS</strong></p> <p>Working knowledge and experience of the Microsoft environment (i.e., Outlook, Word, Access and Excel). Typing speed of 45 wpm is recommended.</p> <p>&nbsp;</p> <p><strong>LANGUAGE SKILLS</strong></p> <p>Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions one on one, from groups of managers, clients, customers and the general public.</p> <p>&nbsp;</p> <p><strong>MATHEMATICAL SKILLS</strong></p> <p>Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Has the ability to apply concepts of basic algebra and geometry.</p> <p>&nbsp;</p> <p><strong>REASONING ABILITY</strong></p> <p>Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.</p> <p>&nbsp;</p> <p><strong>CERTIFICATES, LICENSE, REGISTRATIONS</strong></p> <p>Valid Michigan Driver&rsquo;s License.</p> <p>&nbsp;</p> <p><strong>PHYSICAL DEMANDS</strong></p> <p>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <p>While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; use hands to finger, handle or feel objects, tools or controls and reach with hands and arms.</p> <p>The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.</p> <p>&nbsp;</p> <p><strong>WORK ENVIRONMENT</strong></p> <p>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p> <p>The noise level in the work environment is usually moderate.</p> <p>&nbsp;</p> <p>&nbsp;</p> <p><em>Sanilac County CMH embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence. An employee in this or any position is expected to support the employment environment. This includes having lived experience with behavioral health issues.</em></p> <p>&nbsp;</p>