[Hiring] Billing Specialist @Seneca Family of Agencies

Role Description

The Billing Specialist is responsible for ensuring the accurate and efficient processing of billing and reimbursement for services provided in assigned programs and regions. This role involves:

• Preparing, submitting, and tracking insurance claims.
• Reconciling payments to ensure timely and accurate reimbursement from payers.
• Serving as a key point of contact for addressing billing-related inquiries.
• Supporting multiple programs: Unconditional Education (UE) Outpatient (OP), UE Mosaic, UE Constellation, UE Ala Pathways Medical.

Responsibilities include:

• Prepare and submit accurate claims, invoices, and required documentation for services, including coding diagnoses and procedure codes.
• Monitor and track claims to ensure timely submission and investigate and resolve billing inaccuracies and billing-related issues.
• Check eligibility and benefit verification to determine client’s eligibility and if additional private health insurance exists for each client.
• Collaborate with funders and insurance companies to resolve billing inconsistencies and errors.
• Communicate with program and QA staff regarding any changes to a client’s eligibility.
• Bill and collect copays/deductibles from parents/guardians in applicable programs.
• Upload files to respective systems to apply payments and adjustments and provide reports from the electronic health record system.
• Review billing denial queues and billing-related reports on a daily basis to ensure the timely processing of claims and denials. Resubmit claims as needed.
• Communicate with program staff regarding corrections or necessary changes in documentation.
• Input, complete, and review billing and payment invoices using internal and external Electronic Health Record (EHR) and Clearinghouse systems for assigned program(s) and submit reports in a timely manner.
• Maintain proper documentation for each claim, including relating to the approval or denial of claims, utilizing the appropriate county forms and systems.
• Reconcile payments and resolve discrepancies. Work with payers to appeal and correct errors.
• Stay up to date on changes in billing codes, regulations, and payer policies.
• Attend all required trainings and meetings.

Qualifications

• Bachelor’s degree OR Associate degree + 1 year of applicable work experience OR High school diploma/GED + 2 years of applicable work experience.
• Applicable work experience includes relevant experience in data entry, claims processing, and revenue cycle billing.
• Familiar with most Medical Insurance Payors including Medi-Cal and commercial insurance preferred.
• Strong computer skills with a high level of proficiency in Excel.
• Demonstrated organizational, analytical, and problem-solving skills with the ability to move issues forward to resolution.
• Extremely detail-oriented with strong skills in organizing, tracking, and maintaining large amounts of information.
• At least 21 years of age.
• TB test clearance, fingerprinting clearance, and any other state/federal licensing or certification requirements.

Requirements

• Full-time, Remote
• Monday - Friday, 9am - 5:30pm

Benefits

• Starting at $28.41 - $30.91 per hour.
• Actual salary is dependent on creditable experience above the minimum qualifications for the role.
• Salary increases each year.
• 5 weeks of Paid Time off and 11 Paid Holidays.
• Comprehensive benefits package:
  • Medical, dental, vision, chiropractic, acupuncture, and fertility coverage.
  • 50% paid premiums for dependents.
  • Long-term disability, family leave, and life insurance.
  • 403b Retirement Plan.
  • Employer-paid Employee Assistance Plan.
  • Scholarship opportunities, ongoing training, and professional development opportunities.
  • Seneca is a Public Service Loan Forgiveness certified employer.
  • Promotional opportunities across the agency in California and Washington.