Billing and Claims Specialist

**This position is required to be on-site**

GENERAL STATEMENT OF DUTIES:

The Billing and Claims Specialist is responsible for preparation and delivery of claims to third-party insurance payors and performs follow-up assessments on all discharged patients/residents. The Billing and Claims Specialist will perform other duties necessary to the effective and efficient operation of the department. They will uphold the mission philosophy, and goals of the organization while maintaining strict confidentiality of personnel and patient data and information in the performance of assigned duties.

ESSENTIAL FUNCTIONS:

• Responsible for preparing system spreadsheet for accuracy before uploading to the CRS data reporting system.
• Verifying claim forms from billing system to CRS data reporting system before claims are submitted.
• Responsible for creating claims and data entry of TWC/VR for payment.

• Responsible for submission of all mailed claims with appropriate documentation attached.
• Follow up on outstanding insurance claims to ensure timely payment.
• Review and analyze EOBs to identify underpayments, denials and discrepancies.
• Prepare and submit effective appeals for denials or underpayments.
• Responsible for replying to Billing Request Affidavits for patients in Galveston and Lubbock. Complete necessary Affidavits and submit them to the requesting attorney’s office accordingly.
• Identify payer trends to minimize potential claim denials.
• Document all follow-up activity and payer communications accurately in the system.
• Monitor aging reports and prioritize high-dollar and time-sensitive claims.
• Maintain current knowledge of payer policies, fee schedules, guidelines and billing requirements.
• Documenting all outgoing mail and reviewing frequently to ensure delivery.
• Operate office equipment such as fax machines, copiers, and phone systems.
• Use of Microsoft Office Suite to create Excel spreadsheets and Word documents, database management, and other applications.
• Discharges duties in accordance with Moody Neuro organizational policy, CARF and other accrediting bodies.
• Other duties as assigned

Required Knowledge, Skills and Abilities:

• Microsoft Office Suite
• Knowledge of general office procedures
• Organized and detail-oriented
• Proper telephone and e-mail etiquette
• Proficient typing, filing, verbal, written, and social communication.
• Ability to prioritize and plan workflow to meet deadlines with consistency
• Ability to work and communicate well with others
• Ability to exchange ideas and recommend process improvements
• Ability to operate basic office equipment efficiently
• Ability to display an attitude conducive to the success of the organization
• Flexibility of assigned tasks and duties
• Demonstrate NCI abilities and knowledge by successfully passing course and maintaining refresher courses as determined by the NCI committee
• Maintain CPR certification

Education:

High school diploma, prefer some college.

Experience:

Minimum of two years of experience in medical billing

Demands and Characteristics of Work, Equipment Usage, and Work Environment

Percentage of Work Time (34-66%):

• Twisting

• Climbing (Ascending/Descending)
• Pushing/Pulling
• Bending/Stooping
• Using arm muscles frequently or for extended periods
• Using leg muscles frequently or for extended periods
• Using back muscles frequently or for extended periods

Percentage of Work Time (67-100%):

• Standing/Walking
• Sitting
• Lifting/Carrying

LIFTING REQUIREMENTS - Individuals in clinical care positions are required to lift a trainee/client without assistance. (1-33%)

• 2 - 10 Pounds
• 11 - 20 Pounds
• 21 - 30 Pounds
• 31 - 40 Pounds
• 41 - 50 Pounds
• 51 - Pounds or more

DOES THIS JOB REQUIRE? (1-33%)

• Working in hot, cold, wet surrounds
• Working outdoors
• Working with or near chemicals
• Working near radiation sources
• Potential exposure to communicable diseases
• Working with hazardous waste materials
• Utilizing essential upgraded or adaptive equipment as industry standards require
• Using hand tools
• Operating vehicle

DOES THIS JOB REQUIRE? (34-66%)

• Potential for cuts and bruises

EXCHANGE OF IDEAS (67-100%)

• Ability to express or exchange ideas
• Ability to understand communication of others with or without adaptive devices.
• Obtaining impressions through the eyes of the shape, size, distance, motion, color or other characteristics of objects with or without adaptive devices. The major visual functions are:
  • Acuity, far - clarity of vision at 20 feet or more.
  • Acuity, near - clarity of vision at 20 inches or less.
  • Depth perception - three-dimensional vision. The ability to judge distance and space relationships so as to see objects where and as they actually are they actually are.
  • Field of vision - the area that can be seen up and down or to the right or left while the eyes are fixed on a given point.
  • Accommodation - adjustment of the lens of the eye to bring an object into sharp focus. This item is especially important when doing near-point work at varying distances from the eye.
  • Color vision - the ability to identify and distinguish colors.
• Regular Attendance
• Punctuality
• Ability to do Math
• Literate