Hybrid Billing Specialist-Pediatric Therapy presso None

SUMMARY:  Our Billing Specialist is responsible for full-service billing of claims, including follow-up on denials and reconciliation of claims. Our multidisciplinary team of occupational therapists, physical therapists, and speech therapists work collaboratively to support the developmental and rehabilitative needs of children and their families in the greater Milwaukee area. 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.  Other duties may be assigned.

Essential Duties and Responsibilities:

•  Bill claims, reconcile denials, and issue refunds for Birth to Three (Wisconsin’s Early Intervention Services)  

           through Medicaid, Medicaid HMOs, and Commercial HMOs. 

• Bill Targeted Case Management (TCM), reconcile denials, and issue refunds in ForwardHealth portal. 
• Bill claims, reconcile denials, and issue refunds for outpatient pediatric Occupational, therapy, and   

      speech therapy through Medicaid, Medicaid HMOs, Commercial HMOs and private pay.

• Track benefits for each client including deductibles, copayments, coinsurance and denials. 
• Prepare information and produce invoicing to families for private pay.
• Must have prior application knowledge using electronic medical records (EMR) system and a       

          willingness to learn Empower EMR and Waystar Clearinghouse.

• Ability to understand Service Level Agreement (SLA) involving various contracts and deliver technical 

         demonstrations of application.

• Ability to work well independently with minimal supervision and manage multiple priorities to meet    

         deadlines.

• Assist with Accounts Receivables.
• An option to conduct Contracting/Credentialing tasks for therapists (CAQH, Medicaid contract, State License,

Center certifications in ForwardHealth portal and per insurance).

Education/Experience:

• Associates degree in related discipline of business management, or two years of medical billing or medical 

           billing management experience. 

• Previous Targeted Case Management (TCM) experience required.
• Previous contracting/Credentialing tasks preferred.

 LANGUAGE SKILLS:

• Ability to write concise and informative policy reports. 
• Ability to effectively present information and respond to questions from Board members, members of the leadership team, and customers.
• Regularly, prepare and deliver presentations. 
• Ability to create effective working relationships with staff, vendors, customers and Board of Director members.

REASONING ABILITY:

• This position requires strong analytical skills and the ability to formulate Center strategies and quickly respond to changing conditions.

• Perform problem management activities such as Root cause analysis of incidents.

• Change adaptability and a desire to become innovative and efficient to the needs of the supporting departments and apply sound solutions and ongoing learning to departments that are supported.   
• Excellent documentation skills, interpersonal, and communication skills. 

OTHER SKILLS and ABILITIES:

Excellent communication skills and ability to work in a multicultural environment.   Maintain confidentiality of written or verbal information.  Ability to prepare and present on financial statements  and respond to tax and accountant related issues. Strong organizational skills. Valid Wisconsin Driver’s license.  Proficiency in EMR database management and computer processes. 

PHYSICAL DEMANDS: 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.   Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  The noise level in the work environment is usually moderate.  Frequently required to work evenings and weekends for meetings or special projects.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by staff assigned to this position.  They are not be construed as an exhaustive list of all responsibilities, duties, and skills required.  All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.