Billing Specialist

The Nord Center is a not-for-profit private organization providing culturally competent and evidence-based behavioral healthcare services that promote recovery, dignity, and well-being for our clients, their families and their communities. Often referred to as a health and human service provider, the Center is governed by a citizen board whose membership includes community residents like you and your neighbors.

POSITION PURPOSE AND OBJECTIVES Contact third party payors to verify client benefits. Obtain and monitor all pre-certifications, authorizations and treatment plans for these clients. Responsible for billing and follow-up for managed care and private insurance claims, Medicare, Medicaid, Spend-down, Central Pharmacy and other third party payors as well as patient payments. Maintains systems needed to support the billing. Inputs service transactions into the agency computer system and acts as the primary contact and liaison between patient, clinical and financial staff and third party payors for these functions, all under the direct supervision of the Director of Billing Services. ESSENTIAL JOB FUNCTIONS - Benefit Verification – contacts third party payors to verify benefits (mental health and prescription) for clients and forwards information and/or instructions to appropriate personnel. Works with clinical and financial staff and clients to explain and coordinate benefits. - Pre-certification – obtain and monitor pre-certifications, authorizations and treatment plans required for clients. This includes obtaining clinical information from staff prior to the expiration date of the authorizations, reviewing documents for completeness and accuracy and forwarding these documents to the third party payor, as well as tracking authorizations when they are returned by the third party payor. Coordinates this process by working with clinical staff and third party payors. - Billing – claim submission for Medicare, Medicaid, managed care, insurance and other third party payors in accordance with internal and external rules and regulations. Coordinates authorizations with billings. Maintains billing information in system. Assures that clear audit trail exists to support client account information. - Posts insurance payments and adjustments in agency computer system and investigates rejected claims for possible resubmission. Works closely with financial intake staff to obtain needed insurance information from clients, as well as obtaining needed clinical information from staff. Follow up on unresolved claims to insure maximization of revenue sources. - Central Pharmacy – responsible for collection, sorting and auditing of all Central Pharmacy service tickets as well as their input into the agency computer system. Post client payments and process and mail client billings on a monthly basis. Handle any client or staff billing questions related to Central Pharmacy as well as distribution and follow up for any required reports. - Self Fee Billing – Post client payments and process and mail client billings on a monthly basis. Handle any client or staff billing questions related to self fee billing as well as distribution and follow up for any required reports. - Data Entry – responsible for the input of select agency service transactions into the agency computer system at the discretion of the Director of Billing. This includes the collection, sorting, and verification of accuracy and compliance of source documents prior to data entry. Responsible for auditing all information entered to assure the integrity of billing, including research and resolution of unbillable or incomplete service transactions. Must work closely with clinicians to assure that client and agency financial/service needs are optimally served. - Spend-down – responsible for submitting spend-down documentation and maintaining spend-down information in the agency computer system. - Maintain provider information files at the discretion and under the direct supervision of the Director of Billing, this may include but is not limited to: submission of managed care provider applications and submitting updates as needed. - Generation of periodic statistical and financial reports. - Work effectively as a team by participating in problem solving and contributing to the overall team development by sharing information and knowledge. - Must react to change productively and handle other tasks as assigned. - Exhibits the knowledge, skills, abilities, and minimum requirements listed in this Position Description. - Credentialing and provider contracts.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED In order to perform the essential functions of this job, the employee must possess the following: A working knowledge of Nord Center Policy and Procedures, including sensitivity to consumers and adherence to clients’ rights, confidentiality, and health and safety issues. Must exhibit sensitivity to different cultures. Because a sizable portion of this position requires data entry, good computer skills and accurate typing skills are required. Many of the responsibilities have monthly deadlines, so time management and organization skills are crucial. Third party billing and pre-certification experience is needed, as well as customer service experience. Experience with Lavender and Wyatt system would be beneficial. WORKING CONDITIONS Almost all time is spent in an office environment, currently in an open area shared with other staff, although the employee will have their own work station. Position requires considerable phone contact with third party payors, clinical staff and clients, as well as written correspondence and faxing. MINIMUM REQUIREMENTS High school diploma or GED with medical specific secondary training preferred. Minimum two years recent computerized third party billing experience with a working knowledge of CPT and ICD 9 coding requirements. Typing and data entry skills. Favorable references and/or evaluations are required. OTHER Bi-lingual (English/Spanish) speaking a plus. Experience with EMR (Electronic Medical Records) a plus. The successful candidate must be extremely organized, detail oriented and has the ability to prioritize and accomplish multiple tasks while working with deadlines.