Medical Billing Specialist
Beacon Treatment Center provides Outpatient Substance Abuse Treatment Services to clients at facilities in Navajo and Apache Counties. We are seeking an experienced billing specialist to handle all aspects of billing and claims submissions under the supervision of the Operations Director.
- Completes billing/claims submissions to multiple payers on a weekly basis
- Maintain spreadsheets and documents for payer reimbursement as required.
- Serves as a resource regarding claims status. Communicates difficult claim situations and helps resolve issues.
- Corrects suspended claims with information provided by Program and/or Administrative Staff resubmits for payment.
- Maintain updated knowledge of the group’s contractual agreements and report any discrepancies in payors reimbursement patterns to the Billing Specialist in writing.
- Maintain updated knowledge of provider manuals and billing guidelines.
- Complete status reports weekly or as instructed.
- Reviews and Reconciles remittances weekly.
- Analyzes claim aging to resolve unpaid claims. Tracks claims until paid.
- Follow-up with payors regarding reimbursement claims in the following interval and status or as defined by management:
- Claims that have received denials for erroneous reasons; follow-up initiated and completed within 10 business days or receipt of notification.
- Claims that require additional documentation; follow-up initiated and completed within 10 business days or receipt of notification.
- Claims that have not been acknowledged; follow-up initiated and completed within 10 business days after receipt.
- Initiate first and second level appeal, grievances, reconsiderations, redeterminations, and all categories of disputes required to secure reimbursement .
- Assist with Prior Authorization management.
- Assist Billing Specialist with the hearing process to mediation.
- Meet assigned deadlines and communicate status with management.
- Assist with special projects as needed.
- All other duties as assigned.
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