Billing Specialist

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