Community First Solutions is a not-for-profit network that provides a broad continuum of high-quality services to meet the diverse health and wellness needs of more than 30,000 individuals throughout the region. Commitment to our mission drives our organizational priorities, and we reinvest into expanding programs and services for residents and clients.
Our culture embraces innovation, supports professional development, and fosters collaboration and connectivity between teams. We take our jobs very seriously, but we also know that it’s important to laugh and have fun at work.
What We Offer You
- Paid Time Off that can be taken once accrued with no waiting period
- Competitive Medical, Dental, and Vision Insurance
- Zero co-pay on certain routine prescription medications
- Employee education funds that advance career development
- Life Insurance & Supplemental Life Insurance
- Paid holidays & Holiday Pay
- 401(k) retirement savings plan with employer match
- Pay $18 - $21 per hour.
The Billing Specialist oversees all aspects of billing for the business lines assigned including census review and correction, claims creation and submission, follows up on past due accounts, billing for all payers, remittance advice entry, cash posting, and client communication.
Essential Duties and Responsibilities
- Ensures the registration of all residents and clients has been completed accurately before the billing is submitted to the payer(s) of record.
- Verifies all prior authorizations have been obtained as needed by the payer for each service provided to the client, and prior authorization number has been recorded on the client record in the EHR system, to be submitted on the claim
- Verifies billing is complete and accurate and submitted within the payer time guidelines for all commercial payers, including all government payers, and private pay accounts.
- Inputs and validates provider documentation to support the level of services, including correct diagnosis and CPT/billing codes before submitting the claims for payment.
- Understands all payer contract billing guidelines and requirements to submit clean claims accurately upon the first submission for the business line assigned.
- Posts payments and EOB’s from the various payer sources daily.
- Reconciles and balances posted payments against each of the billing systems weekly and at month-end closing.
- Reviews on a monthly basis the outstanding invoices on the open A/R for the business line assigned and follow up as needed.
- Reviews and follows up on outstanding claims after payment has been made, determines the appropriate adjustments for contractual adjustments as needed.
- Reviews all Medicaid pending status clients, in order to file claims timely.
- Follows up on all outstanding claims, determines if the invoice is collectible, or provides feedback to the manager to accrue for the bad debt reserves as needed.
- Works all outstanding credit balances monthly, all government payers must be resolved within 60 days of recognizing the credit balance to the account. Resolved is defined as reviewed, refund request, and or request recoupment to the payer within 60 days of receiving the payment.
- Reviews claims on hold pending documentation from the provider weekly to obtain the outstanding information to bill claims timely to the payer.
- Reviews all patient statements for accuracy and mails out at the close of each month.
- Performs periodic audits and assists with special projects as requested.
- Meets monthly A/R schedule deadlines
- Inputs ancillaries
- All other duties as assigned and/or appropriate to the position.
Minimum Job Requirements
Education: High School Diploma or equivalent
Licenses or other required certifications:
Experience: Minimum of one year experience in a billing specialist position. Experience preferred in a long-term care/skilled nursing facility environment. Experience working on Point Click Care software is a plus
Specialized knowledge, skills, or abilities:
- Basic skills in Microsoft Office products (Excel, Word, Outlook)
- Knowledge of Point Click Care or other EHR software
- Knowledge of Medicare/ Insurance/ Medicaid billing requirements
- Understanding of payer contracts and fee schedules preferred
- Ability to operate a computer and basic office equipment
- Ability to manage relationships with various insurance payers
- Excellent customer service skills
- Excellent verbal, written, and interpersonal communication skills
- Excellent problem-solving skills
- Attention to detail, strong organization, and time management skills
- Responsible use of confidential information
Community First Solutions is an Equal Opportunity Employer