Benefits:

• Paid time off

Job Summary: The medical billing and coding specialist understands prior authorizations and works with

insurance companies, ensures that the agency is paid for services and that client data flows accurately between

clients, practitioners, and third-party payers. This job also entails completing prior authorizations, collecting

client data and delivering to insurance companies, coding in Medicaid and MCO systems, tracking billing

units, navigating billing portals, and credentialing for insurance companies.

QUALIFICATIONS AND EDUCATION REQUIREMENTS

HS diploma or GED required

Knowledge of Medicaid UM and billing required

Clear criminal and CPS/APS background required

Associates or Bachelors degree preferred

Medical billing and coding certificate preferred

Financial and accounting background preferred

PREFERRED SKILLS

Strong Interpersonal skills

Excellent Communication skills

Ability to navigate online portals

Understanding of medical billing and coding

Ability to work with deadlines

Ability to complete tasks without or with minimal supervision

Strong understanding of prior authorizations

Detail oriented

Strong ability to manage time and prioritize tasks

CERTIFICATION
All certifications will be required to be completed prior to start date with revalidation per companys policy
HIPAA
Adult CPR - First Aid
Blood Borne Pathogens
CPI validation required within 30 days of employment with revalidation per companys policy.

ROLE AND RESPONSIBILITIES
Assigning codes to medical procedures, diagnoses, treatments, and services
Preparing and sending invoices or claims for payment, and correcting rejected claims
Following up with patients and insurance companies about outstanding bills, and keeping track of overdue payments
Acting as a critical liaison between the agency, clients, and insurance companies
Monitoring and processing patient data, such as treatment records, insurance plan information, and payment data
Communicate with other members of the agency
Gather information from the team to complete prior authorizations
Complete prior authorizations in MCO and Medicaid UM portals
Maintain a spreadsheet with dates and units remaining to re-authorize in a timely manner
Complete authorizations and prior-authorizations for clients who are new or have exhausted units
Refer patients to outside specialists or agencies when necessary.
Maintain thorough records of patient meetings and progress, both in electronic and paper records, meeting or exceeding Medicaid documentation expectations.
Follow all safety protocols and maintains client confidentiality.
Contribute to practice by accomplishing related tasks as needed.
Complete and maintain updated authorizations and units of clients.
Navigate UM Medicaid and MCO portals
Complete intensive outpatient billing and authorizations
Complete SUD residential billing and authorizations
Complete outpatient billing and authorizations
Complete credentialing processes for the agency.
Participate in audits and reviews.
Maintain updated spreadsheets on Microsoft TEAMS.
Maintain updated calendars in Outlook and electronic scheduling records.
Attend trainings and meetings as assigned.
Stay up to date with current trends, technologies.
Other duties as assigned by supervisors and directors.