Billing Specialist

Job Description

Billing Specialist – Healthcare | BayMark Health Services

The Tone:
This is a full-time role at BayMark Health Services, a progressive substance abuse treatment organization dedicated to providing the highest quality of patient care in both outpatient and inpatient clinic settings. BayMark Health Services is committed to addressing the physical, emotional, and mental aspects of opioid use disorder to help patients achieve long-term recovery and an improved quality of life. This Billing Specialist position is critical for managing all billing processes and claims submissions, ensuring the financial operations run smoothly and directly supporting the continuity of care for individuals striving to overcome the opioid epidemic.

The TL;DR
• Role: Full Time
• Type: Full-time
• Location: In-person

• Mission: To manage billing processes, claims submissions, and accounts receivable to ensure the financial health and continuity of patient care services.
• Tech Stack: Microsoft Excel, ICD-9 coding, CPT codes, UB04, 1500 claim forms, HIPAA policies

What You’ll Actually Do
• Claims Submission: Accurately enter charges and bill claims to various insurance companies, ensuring timely and correct submissions.
• Accounts Receivable Management: Conduct comprehensive medical AR follow-up procedures, including reviewing aging reports, addressing denials, and managing insurance correspondence from multiple carriers.
• Account Auditing & Documentation: Analyze, audit, and meticulously document all actions taken on each account to maintain clear records and track resolution progress.
• Claim Resolution & Communication: Submit and review outstanding claims, proactively contacting insurance carriers and patients as necessary to resolve issues and secure payment.
• Financial Reconciliation: Reconcile various accounts, accurately post payments, and initiate refund requests when appropriate, alongside reporting on patient authorization expirations and maintaining adjustment spreadsheets.

The Must-Haves
• Background: Prior experience in physician office or hospital billing, demonstrating a foundational understanding of healthcare billing operations.
• Expertise: Strong working knowledge of various insurance plans including Texas Medicaid, Medi-Cal, managed care, and commercial plans is essential.
• Skills: Proven proficiency in medical terminology, ICD-9 coding, CPT codes, and the use of UB04 and 1500 claim forms, coupled with high proficiency in Microsoft Excel. Excellent verbal and written communication skills are also required.
• Bonus: Five years of physician office/hospital billing experience is preferred. The ideal candidate will also possess the ability to self-manage work volume, collaborate effectively with co-workers, multitask efficiently, and ensure strict compliance with HIPAA and internal billing policies and procedures.