Billing Specialist - Part Time

JOB SUMMARY

The Billing Specialist is responsible for submitting authorization requests and enrollment forms to insurance providers, ensuring timely and accurate processing of claims. The specialist will also manage billing inquiries, verify patient insurance coverage, and track the status of authorizations and claims. Additionally, the role involves collaborating with clinical staff to gather necessary documentation, correcting and resubmitting any denied claims, and maintaining compliance with all relevant regulatory requirements. The Billing Specialist contributes to the facility's financial health by optimizing revenue cycle processes and supporting the delivery of high-quality care to clients.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

§  Provide comprehensive administrative support to the Vice President of Clinical Services and the Accounting Manager/Finance Department.

§  Ensure compliance with North Carolina licensing statutes, regulations, and contractual LME/MCO policies.

§  Collect and analyze program data, with a specific focus on authorizations and re-authorizations.

§  Address billing inquiries, verify patient coverage, and monitor the status of authorizations and claims.

§  Collaborate with clinical staff and the Finance Department to compile necessary documentation, promptly correcting and resubmitting denied claims within a 72-hour timeframe.

§  Preparation and submission of initial enrollments, target populations, and all documents required for initial authorizations with all MCOs including Alliance, Partners, VAYA

§  Act as the Liaison between Primary Counselor and MCO when additional information is requested

§  Respond to ALL denial emails that are received from MCOs including Alliance, Partners, VAYA

§  Facilitate admission and discharge processes, as well as service planning and service plan reviews

§  Conduct quality assurance reviews to ensure compliance with licensing and contractual obligations

§  Adhere to all HIPPA and confidentiality rules and guidelines

§  Perform additional duties as assigned by the Vice President of Clinical Services within the scope of the position

§  Actively engage as a member of the Hope Haven Clinical Team

§  Attending all required organizational meetings.

POSITION QUALIFICATIONS: 

§  Associate or bachelor’s degree in the Human Services Field or related discipline with a minimum of one (1) year of related experience preferred.

§  Proficient in Microsoft Office Suite, with an ability to learn additional reporting software as required.

§  Ability to work effectively with a diverse, underserved population.

PHYSICAL REQUIREMENTS:

·        Keyboarding

·        Walking/Sitting

·        Lifting