Medical Billing Specialist

POSTION TYPE: Hybrid

PAY RANGE: $53,600 - $67,000 depending on years of experience

POSITION SUMMARYThe Medical Billing Specialist plays a vital role in the accuracy of our billing records and ensuring prompt payment. This position is responsible for managing claims, conducting eligibility reviews, following up on denials, and resolving issues in a timely manner. Reporting to the Billing Team Lead, the specialist provides billing support across multiple program areas. Strong attention to detail, dependable communication, and consistent adherence to deadlines are essential to success in this role.

KEY RESPONSIBILITIES

• Supports Community Connections processes for insurance eligibility, coverage and authorization process
• Pre-billing (weekly):
  • Review and resolve services with errors within the SmartCare EHR platform prior to claims transmission.
  • Collaborate with Senior Billing Manager and Team Lead when difficulties resolving services are encountered.
  • Track and report pre-billing error trends to Senior Billing Manager and Billing Team Lead to ensure seamless process improvement
• Post-billing:
  • Review weekly ERA/EOB documents/files for denied claims for all programs.
  • On a monthly basis, review detailed aging report for unpaid claims older than 90 days for all programs.
  • Investigate unpaid or denied claims, fix issues, and resubmit as needed.
• Monitor Billing email account and handle billing questions from insurers, providers, and consumers with promptness and clarity.
• Document and clarify missing or unclear billing information.
• Keep up with billing rules and quickly share important updates with the team.
• Support the billing team and assist with related tasks as assigned, including serving as a backup.
• Flag and escalate complex problems to the Billing Team Lead.

In addition to role responsibilities, each staff member of Community Connections has the following responsibilities as a part of their employment:

• Maintains current training requirements, attends necessary meetings and performs other duties as assigned.
• Models and reinforces Community Connections mission to provide behavioral health, residential services, and primary health care coordination for marginalized and disenfranchised women, men, youth, and children living in the District of Columbia, many of whom are coping with challenges including mental illness, addiction, and the aftermath of trauma and abuse.
• Models and reinforces Community Connections values of quality, innovation, respect, equity, and integrity daily.
• Reinforces Community Connection’s commitment to diversity, equity, and inclusion.
• Protects the privacy of our consumer’s protected health information by maintaining compliance with HIPAA and other relevant CC related IT security regulations.
• Completes and stays current on role specific and organizational wide training.
• Performs other duties as assigned on an as-needed basis.

DESIRED KNOWLEDGE, SKILLS & ABILITIES:

• High school diploma or equivalent required; advanced degree preferred
• Minimum of 1 year of revenue cycle experience preferred
• Proficient with billing databases; medical billing experience a plus
• Strong computer skills, accurate typing ability, and advanced proficiency in Excel
• Proficient in Microsoft Office applications
• Excellent interpersonal and communication skills, able to engage effectively with employees, consumers, and vendors at all levels
• Demonstrates professionalism, integrity, and maintains confidentiality
• Customer service focused
• Highly organized and able to meet deadlines consistently

POSITION TYPE/EXPECTED HOURS OF WORK

• May need to work untraditional work hours such as weekends, evenings, observed holidays, and nights.
• This is an essential or critical position which will require reporting to a physical work location or making visits to consumers in the community as defined by the business needs of Community Connections, Inc