Medical Billing Specialist

Description

POSITION: Medical Billing Specialist

PROGRAM: Volunteers of America of Massachusetts-Across Programs

REPORTS TO: Director of Revenue Cycle Management

FUNCTION: 

Medical Billing Specialist determines whether a person is currently enrolled or eligible for enrollment in Medicaid and/or Medicare and/or Medicare and other forms of government aid related to health care. Medical Billing Specialist works closely with stakeholders, and VOAMASS programs to ensure that new clients are admitted into the programs. Medical Billing Specialist enters persons served into the EHR, schedules diagnostic sessions, and helps manage the waitlist for persons served. Medical Billing Specialist manages prior authorizations and reauthorizations for all VOAMASS programs. Medical Billing Specialist works closely with the Director of Revenue Cycle Management to ensure that we are efficiently submitting claims, accurately posting payments, resolving denials, and updating the EHR billing system. Will also help with payment posting and will help with the enhancement of company financial operational objectives for managed care organizations. Medical Billing Specialist will assist the BHS receptionist team, when needed. 

PRINCIPLE ACTIVITIES:

1. Coordinates closely with the intake department and checks eligibility for all individuals that VOAMASS serves to determine Medicaid and/or Medicare and/or Medicare enrollment or eligibility for enrollment.

2. Screens and schedules all new client appointments and manages the waitlist for services. 

3. Documents insurance verification information, cross references address listed on insurance verification, and documents individuals who are ineligible and eligible but not enrolled in Medicaid and/or Medicare and/or Medicare insurance. 

4. Collects co-payments and manages persons served account and benefits.

5. Manages prior authorizations and reauthorizations for all VOAMASS programs. Coordinates with program leadership to ensure that authorizations for services are completed correctly and on-time. 

6. Communicate effectively with client’s integrated care team and VOAMASS programs to prevent insurance issues, correct insurance issues, and resolve gaps in insurance coverage.

7. Participate in program and professional supervision, attend required staff meetings and trainings, and contribute to team-based collaborative planning.

8. Medical Billing Specialist will assist the BHS receptionist team, when needed. 

Effect on End Results: 

1. Increase Medicaid and/or Medicare coverage for persons served and prevent loss of insurance. 

2. Increase overall workflow from referrals, to schedule, to appointments.

3. Increase accuracy of prior authorizations and billing collections and decrease number of billing errors or incorrect payments. 

Requirements

QUALIFICATIONS:

Minimum of two years’ experience in health plan, ancillary, or supplemental network enrollment work. Knowledge of Medicaid and/or Medicare and/or Medicare enrollment services and process. Excellent communication skills, organization skills, and computer skills are required. Experience with CPT codes and billing of managed care operations.