Billing Specialist

Join a purpose-driven team at Caron Treatment Centers, where for nearly 70 years, we’ve been helping people find a path to recovery from addiction and rebuild their lives. We offer real careers with real opportunities for growth, comprehensive training, and a commitment to work-life balance. Our benefits include generous paid time off, professional growth and development, company-paid life and disability insurance, tuition reimbursement, a competitive 401(k) plan, and robust medical, dental, and vision plans. We’re proud to foster a diverse and inclusive environment, with a culture of teamwork, compassion, and dedication to our mission. Start a career that saves lives at a company that values yours!

DUTIES AND RESPONSIBILITIES:

• Review patient account activity to obtain understanding of remaining outstanding amounts due from the patient or insurance funding sources.
• Submit clean claims on a timely basis and contact third party payers to obtain claim status and clarification regarding claim payment denials.
• Assertively pursue proper adjudication of claim with third party payer while serving as an advocate to both the organization and patient to receive maximum appropriate payment
• Process necessary adjustments to the patient’s account to reflect net amounts due after scholarships and contracted discounts.
• Prepare timely and accurate patient statements and refund requests according to department policies and procedures and ensure proper mailing of same.
• Respond to all phone calls from patients and private parties regarding any inquiry related to patient account status, including prior insurance payments or denials.
• Be able to properly communicate to patients’ organizational policies regarding scholarship funding.
• Work with appropriate responsible parties to arrange for payment plans or other funding alternatives according to department policy.
• Prepare and coordinate all necessary documents and correspondence related to payment plans.
• Assists with the submission and processing of all accounts sent to an external collection agency.
• Communicate with the Supervisor of Patient Billing and Accounting regarding any potential adjustments to account balances.
• Always maintain professionalism when communicating and resolving outstanding balances with patients and third-party funding sources.
• Work with internal departments to provide patients with any requested (and appropriate) information related to their treatment that may assist them with potential cost recovery.
• Support other department members with revenue cycle functions during staffing shortages and absences.
• Assist Department Leadership in achieving goals and objectives established by Senior Leadership for the department.
• Utilize the electronic systems and software so that maximum efficiencies are obtained and appropriately escalate issues related to such systems to the proper personnel.
• Abide by any provisions outlined in Third Party Reimbursement Contracts when performing revenue cycle functions.
• Maintain the integrity of all elements of the revenue cycle database when performing related revenue cycle functions.
• Assist with the training and orientation of new employees as directed by Department Leadership.
• This job description reflects management’s assignment of essential functions; it does not prescribe or restrict other tasks that may be assigned.

Education / Experience Qualifications:

• High school diploma or equivalent required
• 2 years’ previous experience in an electronic billing environment required
• Knowledge of health insurance medical billing policies and procedures required
• Previous experience in electronic claims submission and remittance processes preferred
• If in recovery, 1 year of continuous sobriety preferred

Physical Requirements:

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

• Must be able to lift up to 25 pounds
• Will need to sit, stand and type for extended periods of time

Knowledge, Skills and Abilities:

• Proficiency with electronic billing management systems, including claims submission and electronic remittance advice processes.
• Can work successfully in a high-pressure environment and respond to multiple priorities.
• Ability to work as a member of a team and to proactively identify necessary changes to processes and procedures which lead to greater efficiencies.
• Capable of resolving problems independently, coupled with the ability to discern the need for escalation and intervention.
• Detail oriented with strong organizational skills.
• Strong technical knowledge and proficiency with computer software systems, specifically Microsoft products such as Power Point, Excel, and Word and data base management systems.
• Must possess excellent communication and customer service skills and have a pleasant phone manner.

Competencies / Measurements:

• Ensures that information contained in the patient’s account is accurate and complete as measured by Department statistics and AR management reports.
• Demonstrates understanding of third-party payers’ policies and procedures regarding claims submission as measured by supervisory observation and AR management reports.
• Exhibits superior customer service toward patients, families and internal customers as measured by supervisory observation and 360 feedback during performance evaluation.
• Demonstrates ability to utilize electronic billing system efficiently and effectively and ensures data captured is accurate and complete as measured by supervisory observation and revenue cycle reports.
• The Department meets all identified standards of practice and follows all policies and procedures as evidenced in documents and policy manual reviews.