General Position Description:
This position will provide support to the Financial, Quality, and Reimbursement strategies and initiatives for the agency including but not limited to: Primary Insurance Verification, Staff Assistance for reimbursement needs, Medicaid enrollment assistance to consumers, Staff and Agency Credentialing, Claims knowledge, Compliance, Accreditation, Outcomes management, Data collection and analysis, Reporting as assigned.
Performance Expectations and Competencies:
1) Demonstrated ability to provide primary insurance coverage verification and compliance for the agency.
a) Responsible for Insurance Verification for the agency as a whole. Will provide assistance, instruction and follow up with agency staff, consumers, and payers to ensure that insurance information is correct for billing.
b) Reviews billing systems and documents to assure program compliance for Medicare, Medicaid, IPRS, Mental Health and insurance programs; assures that all appropriate insurance documentation is entered into the claims management system.
c) Maintains information or operational records; screens assigned reports for completeness and mathematical accuracy; lists, abstracts or summarizes data; compiles routine reports from a variety of sources.
d) Prepares bills, abstracts, orders, note, receipts, permits, licenses, etc; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data to the patient payer system; maintain records and prepares reports in accordance with predetermined forms and procedures.
2) Monitoring and reporting of client accounts receivables for accuracy and payment potential.
3) Demonstrated ability to provide analysis and critical thinking to support the Quality and Performance Improvement strategies and initiatives for the agency to include but not limited to:
i) Advanced knowledge of Credentialing methodologies and practices
ii) General oversight of NC Tracks processes
iii) Advanced knowledge of CAQH
iv) General oversight of Licensure and maintenance for all staff including current and newly hired staff to include but not limited to tracking of effective dates, renewal dates,
v) General oversight of contractual requirements around credentialing
i) Knowledge of compliance requirements for service provision
ii) Knowledge of compliance requirements for post-payment reviews
iii) Ability to summarize, and report on credentialing compliance issues to senior management staff for improvements to the system
iv) Knowledge of Health Information methodologies to assist with the EHR platform issues and compliance reviews.
i) Should possess strong verbal and written communication skills to create and assist with taking of minutes, preparation of agendas, and professional correspondence as needed both physically and electronically.
ii) Ability to communicate with staff and external agents regarding compliance within the agency as directed.
d) Responsible for the enrollment, credentialing, and re-credentialing of agency/staff with all payers of record.
4) Will work directly with consumers and Medicaid plans for transferring between Medicaid PHP’s and the tailored plans.
5) Will have assigned reports around duties monthly, quarterly, and annually.
6) Will assist staff and consumers with pursuance of Medicaid enrollment
7) Other duties as assigned.
Schedule: Full time, location negotiable
Knowledge, Skills and Abilities:
• Comprehensive knowledge of health care third-party reimbursement programs such as Medicare, Medicaid, IPRS or private insurance
• Comprehensive knowledge of the purposes, methods and practices of billing, accounts receivable and collection of both first and third party sources
• Comprehensive knowledge of contracting, enrollment, and credentialing practices and methodologies
• Ability to work with internal and external staff to assist in Medicaid enrollment. Will work with DSS and payers for compliance with program/payer requirements.
• Modern office practices and procedures, including business correspondence
• Filing, office equipment operations and on-line computers/software
• Intermediate math skills
• Customer service techniques and practices
• Comprehensive knowledge of billing and accounts receivable practices and Electronic Medical Records for data mining.
• Working knowledge of File formatting including office products such as Excel and Access
• Basic knowledge of accounting principles
• Understanding and knowledge of rules and regulations around Mental Health Substance Use and Developmental disabilities.
• Knowledge of CMS and Department of Insurance requirements
• Knowledge of NPPES, CAQH, and NCTRACK enrollment process.
• Knowledge of Database basics
• Prepare financial reports and review of patient accounts
• Interpret program billing policies, procedures and billing regulations
• Work independently with minimal direct supervision; plan and organize work
• Ability to lead and train staff in clerical and reimbursement methods
• Ability to work professionally with licensed staff and external agencies for credentialing and enrollment into payer organizations.
• Ability to create and understand contracts and applications for payer enrollment.
• Ability to follow oral and written directions
• Read and interpret procedure manuals
• Input accurate data into various computer systems in a timely manner
• Maintain patient confidentiality
• Use 10-key adding machine
• Adjust to changes in workflow and meeting deadlines
• Communicate effectively electronic, orally and in writing
Associates in Billing or Healthcare Management and a minimum of 2 years’ experience in a medical office or behavioral health setting or an equivalent combination of education and experience.
Additional Position Requirements:
Must have valid driver’s license and reliable transportation