Billing Specialist

MARQUETTE COUNTY JOB DESCRIPTION
BILLING SPECIALIST

DEPARTMENT: Human Services JOB STATUS: Full-time

SUPERVISOR: Financial & Business PAY CLASSIFICATION: G
Manager

SUMMARY:
Under general supervision, the Billing Specialist is responsible for management of the accounts receivable portion of the agency’s business functions. Maintains accounts for agency clients: posting (inpatient and outpatient) charges and receipts into the agency computer system, generating, transmitting, and following up insurance claims and working with insurance companies and other third-party payers, monitoring the status of client payments, maintaining and updating prior authorizations as necessary, and working with designated agents in identifying and collecting delinquent accounts. Responsible for processing billing logs, and for posting, coding, and depositing funds received. Assists in the reconciliation of agency accounts and documents received from the State and County accounting systems. Responsible for implementing agency billing and collection policies. Assists in the development and revision of agency fiscal policies as requested, in accordance with applicable rules and regulations (e.g. Title 18, Title 19, Uniform Fee System, Social Security
Administration, etc.). Generates monthly fiscal reports as requested or required by the management staff of the
Human Services Department. Work at this level is typically specialized and complex requiring coordination and prioritization of activities and excellent communication skills. This position must understand and follow accounting principles and allowable cost rules for a variety of state and federally funded programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
The following duties are illustrative and the person holding this position may be required to perform other duties as assigned.

1. Responsible for the management of agency accounts receivable. Maintains client account information, including: insurance coverage; client demographic information; charges for services by therapists, RNs, case managers, mentors, counselors, and psychiatrists, etc.; amounts billed to and received from applicable payers, etc., using the agency computer system.

2. Responsible for accurately posting charges and revenues to appropriate client account, for coding receipts to pertinent accounts within the agency chart of accounts, and for making deposits into agency accounts (in accordance with the County Treasurer, HSD Financial & Business Manager, and/or applicable financial institutions).

3. Responsible for the accurate generation, processing, entry/transmittal and tracking of claims to all applicable third-party payers for all billable services, which include, but are not limited to Targeted
Case Management, Comprehensive Community Services, Crisis, Outpatient Clinic, Community
Support Program, Children’s Long-Term Support, Birth to 3, and other certified fee-for-service programs, as documented by applicable agency staff. Serves as resource to staff regarding types of services which are billable. Responsible for recommending modifications to existing processes for better efficiencies.

4. Responsible for client financial files, including applicable authorization forms, remittance advices, invoices, etc. Responsible for working directly with third-party payers requiring prior authorization for services, including the accurate completion and submission of appropriate prior authorization forms. Responsible for assuring that releases, authorizations, etc. are current so that claims may be filed in a timely manner. Responsible for assuring documentation follows GAASB accounting standards and the Center for Medicare & Medicaid Services (CMS) rules.

Job Description-Billing Specialist 1 6/19 JV/MJS

5. Responsible for assisting service providers (e.g. counselors, therapists, APNPs, psychiatrists, etc.) in obtaining and retaining credentialing with third-party payers requiring such enrollment (e.g.
Medicaid, HMOs).

6. As requested or identified, serves as resource to the agency for (re-)determination of client financial responsibility and/or maximization of programs/funding sources for client services.

7. Prepares monthly reports of funds received, accounts receivable, and delinquent accounts for use and as directed by agency management staff. Self-audits work to ensure accuracy and works with
Financial & Business Manager, if necessary, to correct issues.

8. The Human Services Department’s staff operates on a team approach; therefore, this position may be asked to do something other than its regular duties by the department management staff for the efficiency of the department. For example, this position may be asked to provide clerical support for the agency in the absence of other clerical staff, including typing, receptionist duties, entry of data into the agency computer system, etc. or other on-going clerical, fiscal and support duties as assigned by the Financial & Business Manager or Director.

9. Responsible for making suggestions to improve program operations, existing service delivery systems, service selection and coordination on a systemic or individual client basis. Responsible for identifying problems and barriers and for recommending appropriate solutions. Responsible for contributing to a productive, harmonious, and cooperative work environment.

10. Adhere to confidentiality standards.
11. Perform other duties and responsibilities as assigned.

REQUIRED QUALIFICATIONS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• Associate degree required. In lieu of an Associate Degree, a combination of High School Diploma and

5 years billing experience will be considered.

• Three to five years of accounts receivable experience, with an emphasis on third party billing, is desirable.
• Requires keyboarding and typing skills of 50 wpm.
• Requires a valid Wisconsin driver’s license and own transportation.
• Applicants must pass background checks.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Ability to respond professionally to common inquiries or complaints from customers, the public, other

County Departments, the business community and colleagues.

• Requires knowledge of accounting practices and of applicable Federal, State, and County requirements.

Requires thorough knowledge of the policies and regulations of Medicare, Medicaid, and Social
Security, as well as applicable State of Wisconsin regulations (Uniform Fee System, Collection Users
Guide, etc.).

• Requires the ability to enter data rapidly and accurately into various software programs. Requires exceptional attention to detail and the ability to monitor closely the status of simultaneous, multiple insurance claims.
• Requires experience and expertise in several software programs, including Microsoft Windows,

Microsoft Office (Word, Outlook, Excel, etc.). Prior experience with accounting and billing software desirable.

• Requires excellent interpersonal skills, analytical, problem-solving and organizational abilities, as well as the ability to support the work of clinicians and other professionals. Requires a solution-oriented approach and the ability to generate creative helpful solutions to problems. Requires the ability to follow directions, apply appropriate agency policies, complete projects in a timely manner, and be a team player.

Job Description-Billing Specialist 2 6/19 JV/MJS

• Requires the ability to work with minimal supervision in a fast-paced and stressful environment focusing on client treatment and habilitation. Requires the ability to maintain the confidentiality of client, staff, and agency information.
• Requires self-direction, the ability to work independently and to deal calmly with and prioritize multiple simultaneous demands, sound time management skills, and the ability to plan and process work efficiently and accurately under pressure.
• Requires excellent interpersonal skills, pleasant telephone voice, phone etiquette, helpful attitude, and a problem-solving approach to internal/external situations.
• Requires the ability to understand and carry out written and oral instructions, complete projects in a timely manner, be a team player, and to communicate effectively with the public even under duress.
• Competency in attention to detail, typing, grammar, and punctuation
• Ability to operate standard office equipment including but not limited to: telephone, calculator, fax machine, photocopier, scanner, printer and computer.

PHYSICAL DEMANDS:
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.

While performing the duties of this job, the employee is regularly required to use keyboards and other controls, reach, bend and sit. The employee is required to talk, hear and see. The employee must occasionally lift and/or move up to 50 pounds. The employee normally performs work from a sedentary position.

WORK ENVIRONMENT:
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.

The normal work environment for this position is in an office. The noise level in the work environment is usually moderate. Bloodborne pathogen exposure for this position is considered minimal.

Job Type: Full-time

Pay: $20.12 - $23.08 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• Associate (Required)

Experience:

• Accounts receivable: 3 years (Required)

Work Location: In person