mt-wolf Work Opportunities ∙ Page 1

Description

JOB SUMMARY

The Insurance and Billing Specialist position ensures coordination and communication between departments and is a resource/advocate for clients, providers, and Leg Up Farm. The Insurance and Billing Specialist position is responsible for verifying eligibility and benefits and obtaining authorizations for all scheduled treatments. The position is also responsible for billing for services rendered, including posting daily receipts, processing and sending claims, managing the denial process, and reviewing accounts receivable for claims outstanding more than 90 days. 

ESSENTIAL JOB FUNCTIONS

• Input all required data into Leg Up Farm’s web-based computer application.
• Ensure completeness and accuracy of electronic medical records (EMR) and billing records through frequent verification, audit, and updates as required.
• Obtain complete and accurate insurance information and verify insurance by contacting clients/caregivers, physician offices, and applicable insurance/payor.
• Verify and document all available health insurance benefits, including co-payment amounts and required preauthorizations.
• Ensure health insurance benefits are clearly communicated and understood by the client’s primary caregiver(s) and/or responsible parties.
• Maintain up-to-date expertise and knowledge of healthcare billing laws, rules, regulations, and developments necessary for the Organization to make informed business decisions.
• Answer questions from clients/caregiver(s), clerical staff, providers, and insurance companies.
•  Identify and resolve client billing complaints.
• Monitor EFT posting, billing, and collection operations for compliance with established policies and procedures, regulations, and standards.
• Provide back-up to the Receptionist at the Front Desk.
• Process claims using Leg Up Farm's web based computer application.
• Oversee claims denial management tasks.

Requirements

JOB QUALIFICATIONS

Required:

• High school diploma or general education degree (GED)
• Completion of New Staff Orientation Trainings 
• Mandated Reporting and Child Abuse Training 
• First Aid & CPR/AED Certification 
• Current State Child Abuse History Clearance 
• Current State Police Record Check 
• Current Federal Criminal History Background Check (FBI Fingerprinting) 
• Compliance with Drug Testing & Satisfactory Drug Testing Results
• Knowledge of general medical terminology and healthcare benefits 
• Knowledge of outpatient medical insurance and billing, CPT coding, and Medicaid reimbursement 
• Knowledge of Leg Up Farm Therapy Program policies and procedures 
• Knowledge of client’s right to privacy and protection and HIPAA guidelines 
• Intermediate Computer Literacy Skills including word processing, spreadsheets, and emails 
• Excellent skills in verbal and written communication, including telephone etiquette
• Highly detail-oriented, able to work independently, multi-task, enjoy interfacing with other staff at all levels 
• Ability to respond to common inquiries or complaints from clients, regulatory agencies, or members of the business community. 
• Ability to communicate clearly and effectively, both orally and written 
• Ability to maintain strict confidentiality of protected health information (PHI) and proprietary business practices 
• Strong Commitment to Organization’s Mission, Vision, & Culture of Positive Attitude, Passion, Teamwork, and Respect 
• High Degree of Personal Integrity and Professional Conduct 
• High Degree of Flexibility and Dependability 
• Deep Sense of Compassion and Responsiveness to Client’s Needs 
• Exemplify the six Guiding Principles of Leg Up Farm:

1. We will remember to HAVE FUN!
2. We are supportive and respect everyone we interact with and treat them as family.
3.  We are “present” in all interactions.
4.  We foster a “can-do” attitude by focusing on the strengths and creativity of each individual.
5.  We are committed to continual improvement, both personally and professionally.
6.  We are open to change, so we can be innovative.

Preferred:

• Associate degree or higher from specialized business or trade school in human services-related field 
• One or more years experience in an outpatient healthcare clinic
• Safe Crisis Management Certification
• Bilingual 

WORKING CONDITIONS

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance, stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate. This position is subject to a number of inherent risks associated with equine activities. There is a potential exposure to dander of animals. This position is subject to a number of inherent risks associated with pediatric services which is not limited to bites, kicks, scratches, and hits.

DISCLAIMER

The information contained in this job description is not intended to be an all-inclusive list of the duties and responsibilities of the job, nor is it intended to be an all-inclusive list of the knowledge, skills, and abilities required to do the job.

Management may, at its discretion, assign or reassign duties and responsibilities to this job at any time. The duties and responsibilities in this job description may be subject to change at any time due to reasonable accommodation or other reasons.

Further, this document does not create an employment contract, implied or otherwise, or the expectation of continued employment. LEG UP FARM is and will maintain an “at-will” employment relationship with all employees. The employment relationship may be terminated at any time by either party for any reason, or for no reason, with or without cause and with or without notice.