Job Summary: Billing Specialist is responsible for scrubbing and processing billing claims for Health Services and addressing claim rejections in a timely manner.   

Essential Duties and Responsibilities 

• System
• Access the following systems daily to complete Front end Biller tasks and responsibilities:
• NextGen (Electronic Health Records System)
• Third Party Administrators (TPAs) / Payer Portals
• Promise (PA Medicaid System)
• NaviNet (All-Payer Access provider portal)
• Trizetto
•  Department of Behavioral Health and Intellectual disAbility Services (DBHIDS)
•  Avesis (Health Partners-Dental)
• Charge Capture:
• Review and process pending charges from the EHR into the Practice Management (PM) system
• High level review of encounter insurance, telehealth modifiers and patient types
• Resolve any billing encounters with no charges by entering the appropriate dummy code (zXXXX) depending on EHR documentation.
• Claims Processing:
• Billing Encounters
• Review claim production status report that reflects all claim edits and claim holds on a daily basis
• Address all claim edits and resolve any issues to ensure an accurate claim is produced and all claims have a clean status
• Generate Electronic Data Interface (EDI) File with proper naming convention
• Claims Submission:
• Generate EDI claim batches and submit the files through the clearing houses
• Trizetto
• DBHIDS
• Review of Rejected Claims:
• Monitor claims generated and submitted by the billing department routinely
• Remediate discrepancies within 48 hours
• Download vendor rejection file to S drive in NextGen and upload NextGen response reports to SharePoint
• Review and address any adverse results from the response reports
• Document all follow-up activities in the response file within SharePoint
• Download Vendor (i.e. Trizetto) rejection extract file (excel export) and save in SharePoint
• Document all follow-up activities in the extract file
• Upload rejections related to member insurance/eligibility to SharePoint and alert the benefits counselor to address

The information contained herein is not intended to be an all-inclusive list of the duties and responsibilities of the job. Management may, at its sole discretion, assign or reassign duties and responsibilities to this job at any time.  

Education and Experience Minimum Requirements:

Minimum Experience

• High School Diploma required; bachelor's degree a plus.

Preferred Qualifications

• Knowledge and prior experience with Next Gen a plus.
• Certified coder a plus.

Core Skills:

• Excellent oral and written communication skills.

Physical requirements:

Sedentary work that primarily involves sitting/standing.

Project HOME provides equal employment opportunities to all employees and applicants for employment, without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws. Project HOME prohibits discrimination and harassment of any type.