Billing Specialist

<p>Under the direction of the Data Management Director, and in conjunction with the other billing and data management staff, completes duties as assigned in the areas of billing and data management.</p>

Sandusky, MI

Sanilac County Community Mental Health

<p>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.</p> http://www.sanilaccmh.org/

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Para-professional

$14.77/Hr.-$18.44/Hr.

Overview: <ul> <li>Generate appropriate billing for all 3<sup>rd</sup> party, secondary payer and COFR payers for all services, voiding and correcting errors, reprocessing rejections, and verifying waterfall through appropriate guidelines of insurance payers. Ensuring Medicaid is payer of last resort.&nbsp; Correspond with staff as necessary on issues arising from payer&rsquo;s rules/regulations.</li> <li>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.&nbsp; Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.</li> </ul>
Responsibilities: <ul> <li>Generate appropriate billing for all 3<sup>rd</sup> party, secondary payer and COFR payers for all services, voiding and correcting errors, reprocessing rejections, and verifying waterfall through appropriate guidelines of insurance payers. Ensuring Medicaid is payer of last resort.&nbsp; Correspond with staff as necessary on issues arising from payer&rsquo;s rules/regulations.</li> <li>Process all claims through the computer system claim adjudication process within the appropriate guidelines of the PIHP. Send claim rejections to appropriate staff and follow-up as needed. Submitting invoices to the Finance Department.</li> <li>Enroll staff in appropriate insurance panels (verifying appropriate credentials are in place and current), attend privileging and credentialing committee meetings, and verify staff is not on sanction lists of OIG or the state.</li> <li>Complete monthly, quarterly, and annual reports for Finance and Data Management Directors.</li> <li>Process and submit all encounters and BH TEDS files timely based on the schedule the PIHP sets up.</li> <li>Appropriately enter all AP checks in OASIS.</li> <li>Analyze and maintain costing for injections, including creating rate structure.</li> <li>Credit all insurance payments for services, no matter the form of the remittance; to appropriate individual accounts.</li> <li>Inform staff who complete fee assessments of any changes in insurance coverage for an individual.</li> <li>Generate monthly ability-to-pay statements.</li> <li>Process green sheet paperwork, adjusting funding sources as necessary.</li> <li>Read, distribute and update staff on Medicaid, BCBS, Medicare and MI Child Bulletins.</li> <li>Attend MARO and other billing trainings as needed.</li> <li>Process new providers into computer system and inform appropriate staff when completed. This includes training on claim entry.</li> <li>Enter and update rate schedules as needed or as appropriate in OASIS. Maintain grid and update as needed on website.</li> <li>Other duties as assigned.</li> </ul>
Requirements: <br /> <ul> <li>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.</li> <li>Applicants must have an Associate&rsquo;s Degree or equivalent from 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.</li> <li>Working knowledge and experience of the Microsoft environment (i.e. Outlook, Word, Access and Excel). Typing speed of 45 wpm is recommended.</li> <li>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.</li> <li>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.</li> <li>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.</li> <li>Valid Michigan Driver&rsquo;s License</li> <li>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.</li> <li>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.</li> <li>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.</li> </ul>