Southeastern Arizona Behavioral Health Services, Inc.
Medical Billing Specialist I
Reports To: Medical Billing Manager Salary Grade: 16 FLSA: Non-Exempt
Annualized Salary Range: $19,297 to $27,152
Primary Function: Responsible for prompt and accurate reporting of ADHS encounters and claims processing and to ensure that all EOBs are processed in a timely manner.
Specializations: (Age Specific, Disability, Language, Other Target Populations)
Check All that Apply
__Serious Mental Illness __Adult Substance Abuse
__Adult General Mental Health __Geriatric General Mental Health
__Geriatric Substance Abuse __Child/Adolescent General Mental Health
__Child/Adolescent Substance Abuse
Domestic Violence __Perpetrator __Children/Adolescent __Adult Victim
Bilingual (English/Spanish) __Speak __Read __Write Other Language: __________
Minimum Qualifications: High school diploma or GED preferred, with (1) year experience and/or education in claims processing and accounts receivable, with various duties.
Competencies:
• Knowledge in utilization of personal computer.
• Ability to communicate well verbally and in writing.
• Ability to maintain confidentiality of all client matters and handle organization confidential matters with discretion.
• Ability to keypunch data as necessary.
• Ability to maintain organization of varied materials and apply complex directions quickly and correctly.
• Ability to disseminate contract information to ensure proper billing procedures are implemented and followed.
• Ability to prepare and maintain accurate records.
• Ability to research and resolve denied/pending claims in a timely manner.
• Ability to review paid claims and resolve any discrepancies in a timely manner.
• Knowledge of a computerized accounts receivable.
Tasks:
• Assure prompt and accurate billing and claims processing of all services provided.
• Review paid claims and resolve payment discrepancies.
• Preparation of necessary billing forms as required by RBHA and Third Party Insurances.
• Responsible for electronic submission of claims to RBHA and Third Party Insurances.
• Research and resolve denied claims and billing inquiries.
• Disseminate contract information to ensure proper billing procedures is implemented.
• Assist in special projects as required by the Medical Billing Manager.
• Maintain current knowledge of all funding source reporting requirements and procedures.
• Prepare and review monthly billing and client activity reports to ensure proper billing.
• Performs other duties as assigned.
Accountability: Medical Billing Specialist I will work under the general direction of the Medical Billing Manager. This position holds no supervisory responsibility and is responsible for own work only.
Behavioral Skills Required:
• Coping: Able to maintain a mature, problem-solving attitude while dealing with interpersonal conflict, hazardous conditions, personal rejection, hostility, or time demands.
• Tolerance of Ambiguity: Able to withhold actions or speech in the absence of important information; deal with unresolved situations, frequent change, delays or unexpected events.
• Decisiveness: Able to make decisions on available information and take action; make commitments and not change decisions when challenged; deal with emergencies as necessary.
• Spoken Communications: Able to clearly present information through the spoken word; influence or persuade others through oral presentations in positive or negative circumstances; listen well.
• Assertiveness: Able to maturely express one's opinions and feelings in spite of disagreement; accurately communicate to others regardless of their status or position.
• Compliance and Direction: Able to relate to routine operations in a manner that is consistent with existing solutions to problems; to conform to established policies and procedure; log work activities.
• Alertness: Able to be attentive to all aspects of the environment, while working; to monitor environment during routine activity.
• Analytical Problem Solving: Able to use a systematic approach in solving problems through analysis of problem and evaluation of alternative solutions; use logic, mathematics or other problem-solving tools in data analysis or in generating solutions.
• Goal Setting: Able to define realistic, specific goals and objectives; to prioritize objectives.
• Written Communication: Able to write clearly and effectively present ideas and to document activities; to read and interpret written information.
• Commitment to Task: Able to start and persist with specific courses of action while exhibiting high motivation and a sense of urgency; will to commit to long hours of work and make personal sacrifice in order to reach goals.
• Interaction: Able to communicate with others in a warm and helpful manner while simultaneously building credibility and rapport.
• Creativity: Able to develop unique and novel solutions to problems; use intuition and a new way of thinking to give birth to new ideas; to present information in an attention-getting and interesting manner.
• Team Building: Able to work with people in such a manner as to aid in building high morale and group commitments to goals and objectives.
• Decision Making and Problem Solving: Able to take action in solving problems while exhibiting judgment and a realistic understanding of issues; able to reason; even when dealing with emotional topics.
• Client/Customer Service Orientation: Demonstrates concern for meeting internal and external customers' need in a manner that provides satisfaction for the customer within the resources which can be made available and anticipates additional needs of customers.
• Adaptability/Flexibility: Adapts easily to change, sees the merits of differing positions, and adapts own positions and strategies in response to new information or changes in a situation.
• Personal Growth/Attention to Development: Desires to improve and develop self; sets own development challenges and volunteers to learn.
• Initiative: Evaluates, selects and acts on various methods and strategies for solving problems and meeting objectives before being directed or forced by events; self-directed rather than passively complying with instructions or work orders.
• Teamwork and Collaboration: Able to develop cooperation and collaborative work efforts toward solutions which generally benefit all involved parties.
• Reliability: Instills confidence in others due to proven consistent and positive outcomes.
Cognitive Requirements: Job requires solid reading/comprehension and verbal/written skills, the ability to gather and interpret moderately complex information and the ability to analyze and resolve problems of limited scope and complexity.
Continuous Education: Employees will be expected to participate in continuous learning,
competence building and maintenance of skills. New employees are required to complete twenty-four hours of skill training the first year and twenty-four hours per year thereafter.
Physical Requirements:
• Use a Personal Computer of telephone over five hours a day
• Occasional reaching, bending, stooping, kneeling or crouching
• Infrequent physical effort (infrequent lift/carry up to 25 pounds)
• Ability to operate a motor vehicle
Working Conditions:
• Office working conditions
Performance Metrics:
• Customer Service
• Timeliness of Sending Claims
• Reconciliation Timeliness
• Denial/Pending Claims Resolution Timeliness
• Accuracy of claims (pending)
Computer Skill Requirements:
• Advanced Windows
• Basic Word
• Advanced Excel
• Knowledge of Email functions, contacts and calendars
• Advanced Access database
Mentor Criteria:
• A mentor will be personable and patient, with good, open communication skills. A mentor will be knowledgeable in SEABHS systems and procedures. A mentor will be a self motivated individual with the ability to positively support their peers.
Mentor Scope of Responsibility:
• A mentor provides side by side, hands on shadowing, with consistent and constructive feedback. The mentor oversees accuracy, as well as verbal and visual skills with on-going communication to the direct supervisor.
Career Ladder:
• PAR II
• Administrative Specialist II
• Bookkeeper II
Career Ladder Traits:
• Analytical/ Problem Solving
• Self Motivated
• Able to Read System
• Organization Awareness/Resource
• Interested in Personal Growth
• Detail Oriented
Career Ladder Skills:
• Knowledge of Inter-System
• Knowledge of all operational policies
• Basic Contractual Obligation
• Advanced Computer Skills
• Knowledge of all technical office equipment
• Advanced Office Operations
• Desire to develop leadership skills
Developmental Needs for Career Ladder
• Leadership Training/Mentorship
• Furthering Education
• Technical training in basic office equipment trouble-shooting.
Employee's Name (Printed) Supervisor's Name (Printed)
Employee's Signature Date Supervisor's Signature Date
