Claims Submission:

Prepare, review, and transmit claims to insurance companies(commercial and government) for reimbursement.\n

Revenue Cycle Management:

Monitor claim status, follow up on unpaid claims, and appeal denied claims to ensure timely payment.\n

Patient Billing:

Calculate patient responsibility, send patient statements, and handle inquiries about bills.\n

Compliance:

Adhere to HIPAA regulations to maintain patient confidentiality and comply with all legal/payer requirements. Provide front desk back up support to the LLHS Clinic Front Desk as needed. Be available to train student interns, graduate assistants, and student employees as appropriate. Serve as a mentor modeling professional behavior. Execute Insurance provider enrollment processes and set up. Execute Initial setup and maintenance of credentialing for all affiliated providers. Update and maintain all CAQH Provider Profiles. Proper use and assignment of billing codes.\nKnowledge of HIPAA regulations. Stay up to date on appropriate billing codes and procedures. Balance end of day according to clinic policies and procedures. Track payments from all sources including Touchnet, Clover, Zealous, Availity, WayStar, (and others) as well as Student Accounts. Obtain prior authorizations as needed for allied health provider services. Minimum Qualifications Bachelor's degree; or equivalent combination of training and experience. All degrees must be received from appropriately accredited institutions. License/Certification Required Essential Job Functions The Medical Billing Specialist conducts all billing services for the AppWell Clinic and act as the electronic health records administrator.

This role:

provides clients with a written/and/or verbal determination of fees for all clinical services (evaluation, screening, therapy, etc.\nestablishes and monitors accounts payable and receivable for all clients\nis responsible for all insurance processes such as patient benefit inquiries, prior approval processes and physician referral requests\nsubmits insurance claims by standard or electronic methods\nupdates, monitors & follow-ups all electronic & paper claims\nmonitors delays and denials of claims and prior approval requests.\nassists with data collection for statistical reports. This role has extensive phone & e-mail contact with Medicaid, Medicare, BCBS of NC, other healthcare plans, state & local agencies including CDSA. They will be responsible for insurance provider enrollment process and set-up.\nSecondary responsibilities include assisting office staff, students and clinical faculty with routine and complex office procedures, including electronic health records. Assisting with public inquiries about clinical services and fees, client scheduling, policies & taking referral information. Conducting client file reviews and audits. Updating additions and/or deletions to the clinic materials database. Ordering of clinic diagnostic / therapy test materials and forms. Knowledge, Skills, & Abilities Required for this Position Knowledge of Electronic Health Records and billing policies and insurance guidelines for multiple insurance agencies.\nMust be able to oversee all insurance processes including benefit inquires, prior approvals, and physician referrals.\nUpdate and monitor electronic and paper claims.\nEnsure insurance provider enrollment process and set up.\nWork with Electronic Health Records and oversee implementation of electronic billing process. Proper use and assignment of billing codes.\nKnowledge of HIPAA regulations. Preferred Qualifications Basic office skills, supervisory skills and the ability to produce and evaluate data\nAbility to work independently and without instruction, to handle pressures, to prioritize work and stay focused in a busy environment, to make administrative decisions, to be patient and flexible in a demanding environment, and to provide instruction and oversight for graduate assistant students\nSpecial consideration will be given to individuals with knowledge of electronic health records, private-pay, third party and insurance billing, including claim submissions\nSpecial consideration will also be given to individuals with a certificate or associate's degree in medical billing and coding. Required Functional Competencies to Successfully Perform Job Duties. Knowledge-Program & Organization\nKnowledge of state, federal, policy interpretations and precedents affecting program areas(s) and unique situations. Ability to analyze and explain revisions and implement initiatives. Ability to draft and recommend new procedures. Knowledge of state, federal, policy interpretations and precedents affecting program area(s), and unique situations. Ability to analyze and explain revisions, and implement initiatives. Ability to draft and recommend new procedures. Operational knowledge and the ability to articulate the purpose of the program's organization including its mission, services, clients and measures of business effectiveness in order to adapt processes, procedures and activities to meet needs. Ability to identify, understand and provide possible resolutions for unique issues and problems that with broad impact and/or a broad range of client services. Ability to lead teams in the modification of processes using applicable technology web-based data systems and programs.\nProgram Administration\nAbility to establish expectations and clear directions for a defined program area independently. Ability to make decisions regarding the program expectations and direction to ensure program outcomes and timelines are met. Ability to identify, understand, and provide corrective alternatives for issues and problems of a more complex nature. Ability to adjust program priorities based on changing work environment and deadlines. Ability to analyze and develop information for monitoring and measuring work processes. Ability to determine program effectiveness and efficiency. Ability to identify trends in program operations or activities and make recommendations. Ability to manage the reporting of financial area or program(s), including preparation and analysis of financial statements and reports. Customer Service\nAbility to enhance collaboration among individuals and groups. Ability to build consensus when dealing with opposing points of view, and resolve competing or complex issues. Ability to promote a high level of integrity among all staff. Ability to engage and act in the best interests of the organization by aligning service delivery with strategic goals and client's needs. Knowledge of the unique needs of clients and ability to provide responsive services/answers tailored to their requirements. Ability to maintain quality service standards and recommend improvements. Applies an in-depth knowledge of a variety of complex processes and procedures and independently performs those tasks. Type of Position\tPermanent Full-Time\nStaff/Non-Faculty\tStaff/Non-Faculty\nAppointment Type\t1.0\nWork Schedule/Hours Mon-Fri 8:00-5:00pm Number of Hours Per Week\t40\nNumber of Months Per Year\t12\nMandatory Staff\tNo\nPhysical Demands of Position To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions. Overall Competency Level\tAdvanced\nSalary Grade Equivalency\tGN09\nSalary Range Anticipated Hiring Range\t$48,004 - $50,530\nPay will be commensurate with applicant competencies, budget, equity and market considerations. 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