Offer summary

Qualifications:

High School Diploma or GED required; Medical Billing Certificate preferred., Two or more years of experience in billing with knowledge of commercial insurance and Medicaid policies., Familiarity with CPT, HCPCS, and ICD-9/ICD-10 coding is essential., Experience with Electronic Medical Records (EMR) is preferred. .

Key responsabilities:

Verify client insurance coverage with various funding sources and document in the EMR system.

Maintain understanding of payer billing and prior authorization requirements for all services.

Coordinate with Intake Staff to ensure accurate documentation and update EMR as necessary.

Work with the Billing team to resolve unbilled claims and maintain compliance with regulations.

Job description

Your story. Our mission. A perfect match.

You have a place here at OhioGuidestone, the state’s leader in community behavioral health care serving around 26,000 Ohioans each year. We focus on the needs of the whole person by providing telehealth and in-person prevention services, as well as mental health and substance use treatment. As we help people navigate the most difficult times in their lives—with compassion and respect—we ultimately empower them to take steps towards a healthier future.

The Billing Eligibility Specialist is responsible for the verifying client insurance coverage and understanding payer billing requirements, prior authorization requirements, credentialing, and billing systems while maintaining the highest level of confidentiality.

Duties/Responsibilities:

Verifies client insurance coverage with Medicare, Medicaid, Managed Care Organizations and other funding sources and creates a benefit assignment in the Electronic Medical Record (EMR) System.
Maintains understanding of payer billing requirements, prior authorization requirements, credentialing, and billing system processes for all Agency reimbursable services and contracts.
Contacts insurance companies and patients routinely to ensure benefit eligibility status.
Works with insurance companies, and other funding sources, to obtain the required prior authorizations needed for services and properly documents them in the EMR system.
Completes e-mail requests in the order in which they are received or prioritizing more urgent, timely requests in a shared e-mail inbox, address accurately while working in tandem with team members.
Coordinates with Intake Staff to ensure documentation, demographic, and financial information is complete and accurate, and updates the EMR System as necessary.
Works with Billing team to ensure resolution of unbilled claims and denials so the claims can be billed and collected properly.

Develops and maintains processes to increase the efficiency of the Billing department.

Reviews and updates intake and other department forms routines to ensure compliance.
Performs regular audits for missing benefits or required changes.
Assists in maintaining compliance with current governmental and payer regulations.
May be involved in the planning, organization and implementation of special events or department specific projects or seasonal program changes.

Maintains the confidentiality of client or collateral interaction within Agency defined standards.
Participates in staff trainings, supervisory and staff meetings.

Maintains regular and reliable attendance.
Exhibits positivity, flexibility and a willingness to provide in service training and take on new responsibilities as requested or required.

Required Skills/Abilities:

Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
Computer literacy skills, including Windows applications, Microsoft Office Suite, and basic database usage, as well as moderate level typing.
Strong critical thinking and communication skills to problem solve and interact with staff, representatives from outside agencies and families including but not limited to, in-person, phone and computer.
Visually determine the accuracy, neatness, and thoroughness of work assigned and/or to make general observations of facilities or structures.
Exceptional customer service skills as work is generally performed at a desk and on the phone.
Organizational skills and attention to detail.

Performance/Physical Requirements:

Work environment is based in an office setting and consist of walking, standing, bending, stooping, lifting up to 25 lbs. and remaining in a stationary position a minimum of 75% of the time.

Qualifications:

Minimum educational level is a High School Diploma or GED*, Medical Billing Certificate preferred.
Two or more years of experience in billing with knowledge of commercial insurance and Medicaid policies and benefits, required.
Knowledge of CPT, HCPCS, and ICD-9/ICD-10 coding, as well as requirements for federal and Ohio billing
Experience with Electronic Medical Records (EMR), Evolv preferred.
Must have a valid Ohio Driver’s License with a safe driving record and valid insurance.
Ability to take and pass a physical exam and drug screening.
Employment is contingent upon clear results of a thorough background check.

Benefits include:

NEW higher pay rates
Clear career ladder for development path in various roles
Competitive medical benefits including a zero-cost monthly option for employee or employee + children!
Free CEU trainings
10 paid holidays; two are exchangeable
Flexible work schedules to support work/life balance
Flexible work opportunities to support varying career paths, job roles, intern to hire, and locations
401(k) with employer match option
Employment Assistance Program (EAP)
Mileage reimbursement
Free licensure supervision
Recognition and rewards