Billing Specialist

GENERAL STATEMENT OF JOB

 Under general supervision, this position ensures all billings and payments are collected for services provided.  Reports to the Reimbursement Supervisor.

ESSENTIAL JOB FUNCTIONS

Processes all identified insurance requirement edits and rejects to retransmit with corrected insurance information through the electronic billing system; transmits all electronic claims directly to the insurance carriers, process re-bills submitted to the billing department; and processes electronic insurance daily.

Verifies that all electronic acknowledgements were received by the insurance carriers, verifies eligibility and authorizations; identifies and bill secondary or tertiary insurances; submits required paper billing to insurance carrier on a daily/weekly basis; follow-up with insurance companies regarding any discrepancies in payments and on unpaid claims within standard billing cycle timeframe; interprets Explanation of Benefits (EOBs); and verifies and ensures that all insurance payments are accurate and in compliance with contract discount.

Performs administrative support work such as word processing, creating spreadsheets, data entry and retrieval, and functions that may require interpretation, judgment and determining appropriate processes to be used. Reviews forms, data and other information to ensure accuracy and conformance to established procedures and policies.

Performs other related work as required.  Individual assignments will be determined by supervisor based on current workload and department needs.

PERFORMANCE INDICATORS

 Knowledge of Job: Has thorough knowledge of insurance billing such as practices to ensure accuracy and appropriateness of all transactions, to include compliance with policies and operational requirements.  Has considerable knowledge of principles and processes for providing customer service, including setting and meeting quality standards for services and evaluating customer service.   Has considerable knowledge of arithmetic, spelling, grammar, punctuation and vocabulary. Has considerable knowledge of the policies and procedures, organization and function of the department. Is skilled in the operation of common office equipment, including popular computer-drive word processing, spreadsheet and file maintenance programs. Is able to screen communications and, based on content, handle independently or route to proper source. Is able to correct spelling, grammatical, punctuation and typing errors. Is able to use independent judgment in organizing and establishing format. Is able to gather information from a variety of sources and draft documents. Is able to establish and maintain moderately complex files. Is able to communicate effectively orally and in writing. Is able to exercise tact and courtesy in frequent contact with the general public. Is able to establish and maintain effective working relationships as necessitated by work assignments.

Quality of Work: Maintains high standards of accuracy in exercising duties and responsibilities. Exercises immediate remedial action to correct any quality deficiencies that occur in areas of responsibility. Maintains high quality communication and interacts within department and division, and with co- workers and the general public.

Quantity of Work: Maintains effective and efficient output of all duties and responsibilities as described under "Essential Job Functions."

Dependability: Assumes responsibility for doing assigned work and meeting deadlines. Completes assigned work 

on or before deadlines in accordance with directives, City policy, standards and prescribed procedures. Accepts accountability for meeting assigned responsibilities in the technical, human and conceptual areas.

Attendance: Attends work regularly and adheres to City policies and procedures regarding absences and tardiness. Provides adequate notice to higher management with respect to vacation time and time-off requests.

Initiative and Enthusiasm: Maintains an enthusiastic, self-reliant and self-starting approach to meet job responsibilities and accountability. Strives to anticipate work to be done and initiates proper and acceptable direction for completion of work with a minimum of supervision and instruction.

Judgment: Exercises analytical judgment in areas of responsibility. Identifies problems or situations as they occur and specifies decision objectives. Identifies or assists in identifying alternative solutions to problems or situations. Implements decisions in accordance with prescribed and effective policies and procedures and with a minimum of errors. Seeks expert or experienced advice and researches problems, situations and alternatives before exercising judgment.

Cooperation: Accepts supervisory instruction and direction and strives to meet the goals and objectives of same. Questions such instruction and direction when clarification of results or consequences are justified, i.e., poor communications, variance with City policy or procedures, etc. Offers suggestions and recommendations to encourage and improve cooperation between all staff persons within the department.

Relationships with Others: Shares knowledge with supervisors and staff for mutual and departmental benefit. Contributes to maintaining high morale among all department employees. Develops and maintains cooperative and courteous relationships with department employees, staffers and managers in other departments, representatives from organizations, and the general public so as to maintain good will toward the department and project a good departmental image. Tactfully and effectively handles requests, suggestions and complaints from other departments and persons in order to maintain good will within the City. Interacts effectively with fellow employees, supervisor, professionals and the general public.

Coordination of Work: Plans and organizes daily work routine. Establishes priorities for the completion of work in accordance with sound time-management methodology. Avoids duplication of effort. Estimates expected time of completion of elements of work and establishes a personal schedule accordingly. Attends meetings, planning sessions and discussions on time. Implements work activity in accordance with priorities and estimated schedules. Maintains a calendar for meetings, deadlines and events.

Safety and Housekeeping: Adheres to all safety and housekeeping standards established by the City and various regulatory agencies. Sees that the standards are not violated. Maintains a clean and orderly workplace.

EDUCATION & EXPERIENCE 

Requires an Associate’s Degree and 2 to 3 years of health insurance claims, billing and coding experience; or any equivalent combination of training and experience which provides the required education and experience.

An acceptable general background check to include a local and state criminal history check and sex offender registry check.

A valid driver’s license with an acceptable driving record.

Individuals in this position cannot be listed as having a founded child abuse or neglect complaint.

In the event of a declared emergency in the city of Portsmouth, individuals in this position are required to work shelter duty and may be called on to perform duties as required to provide for the safety and care of the citizens of the community.

MINIMUM QUALIFICATIONS OR STANDARDS REQUIRED TO PERFORM ESSENTIAL JOB FUNCTIONS

Physical Requirements- Must be physically able to operate a variety of automated office machinery and equipment including computer, printer, typewriter, calculator, facsimile machine, copier, multi-line telephone systems, etc. Must be able to exert up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for sedentary work. Light work usually requires walking or standing to a significant degree. However, if the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.

 Data Conception- Requires the ability to compare and/or judge the readily observable, functional, structural, or composite characteristics (whether similar to or divergent from obvious standards) of data, people or things.