Job Details
Mountain Home seeks a full-time Billing Specialist who will play a crucial role in Mountain Home's revenue cycle management process. Mountain Home is in a period of exciting and significant expansion, and the Billing Specialist will help ensure financial stability as we continue to meet our community's needs. The primary functions of this role include submitting claims, analyze claim denials, appeal decisions, resolve any billing discrepancies, and managing aging accounts. Your expertise in insurance billing and reimbursement will be paramount as you navigate complex insurance policies and ensure accurate and timely reimbursement for our services.
The position requires a high school diploma or equivalent, a medical billing and coding certification, and at least two years of insurance billing experience. The ideal candidate is one who exceeds these requirements and also has experience with database administration.
Ideal Start Date: June 2024
Status: Non-Exempt, Full-time, Non-Shift, 40 hours/week
Pay Range: $18.00 - $23.00 hourly wage, based on experience and education
Benefits: Health, Dental, Vision, Life, and Short Term Disability Insurance, Employee Assistance Program (EAP), SIMPLE IRA match of 3%, 25+ days of paid time off annually, paid sabbatical every 5 years, and much more!
Schedule: Flexible, as long as of total hours are performed Monday through Friday 9am - 5pm to ensure timely communication with other appropriate personnel
Location: Hybrid, with most work able to be performed remotely
Travel: This position does not require regular travel (0-5%)
Direct Reports: Not applicable
Reports To: Finance Director
Essential Functions
Insurance Billing
- Manage entire revenue cycle including billing, coding, collections, and denial management.
- Possess a thorough understanding of healthcare regulations and payor requirements.
- Develop, evaluate, revise, and implement policies and procedures related to billing, coding, reimbursement activities, and improvement strategies.
- Responsible for submission of timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission
- Generate telephone calls to insurance carriers to follow up on insurance using reports generated for this purpose to ensure the timely collection of money due on the account
- Audits accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance responsibility to client responsibility when appropriate, and reviews and resolves credit balances
- Ensure that claims have appropriate information on them for submission to insurance companies or agencies by reviewing errors and other pre-billing insurance reports
- Analyzes and review claims to ensure that payer specific regulations and requirements are met
- Prepares and presents verbally and in writing challenges to third party payers for additional reimbursement for denied charges and/or reductions in reimbursement as appropriate
- Responds to inquiries from clients/other departments/insurance carriers regarding insurance coverage issues, coordination of benefits, reconciliation of account balances and complaints regarding services received
- Sets up registration and insurance information when necessary
- Utilizes performance improvement principles to assess and improve quality
- Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements
- Maintains competency in all organizational, departmental and outside agency environmental, employee or client safety standards relevant to job performance
Database Administration
- Input, update, and maintain accurate data on computer systems and in archives
- Compile, verify accuracy, and sort information according to priorities, in order to prepare source data for computer entry
- Review data for deficiencies or errors and correct any incompatibilities
- Research and obtain further information for incomplete documents
- Build and generate reports that are automatically sent to specific staff at certain times according to grant timelines and due dates
- Store completed work in designated locations, and perform backup operations
- Scan documents and print files when needed
- Comply with data integrity and security policies
- Maintain confidentiality of sensitive information
- Respond to requests to retrieve data from the database as needed
Other appropriate and job-related tasks as assigned
KEY PERFORMANCE INDICATORS
- 90% of reimbursement eligible insurance claims are submitted for reimbursement within 7 days of service documented by provider in database
- 95% or more of submitted claims contain no errors
- 5% or less of submitted claims denied (excluding temporarily denied claims due to error)
MEASURES OF ACCOUNTABILITY:
- 65% of time allocated to submitting claims, analyze claim denials, appeal decisions, resolve any billing discrepancies, and managing aging accounts
- 25% of time allocated for database administration responsibilities
- 5% of time allocated to continuous professional development
- 5% of time allocated to meetings, and collaboration
Who We Are
Mountain Home is a fast-growing Missoula nonprofit whose mission is to provide a safe home and nurturing community where young mothers discover their strengths, and children thrive. Since 2000, we have built an effective, holistic model of care that integrates supportive housing, mental health care, employment and education support, trauma-informed childcare, and more. We work closely with young families, donors, and community partners to build brighter futures, two generations at a time. We are an organization that serves our community and our employees. Take a few minutes to read why we are an employer of choice!
Who You Are & Keys to Success
To be successful in this job, you will excel in four areas:
- Commitment to justice, equity, diversity, accessibility, and inclusion: You recognize the role of gender, race, income, age, and other identities in shaping our participant's needs. You realize how your identities show up in the work, and welcome, reflect on, and act on feedback with an eye toward continuous learning about justice, equity, diversity, accessibility, and inclusion.
- Organizing, Time Management, Planning & Prioritizing- You know where you put things and can create and maintain systems to keep track of information or materials. You are known for showing up on time and completing your scheduled hours. You can estimate how long a task will take, how much time you have, how to allocate it, and how to stay within time limits and deadlines. You value the importance of time. You can create a road map to reach a goal or to complete a task. You take intentional steps to make decisions and you make decisions about what is important to focus on.
- Stress Tolerance, Emotional Control, & Flexibility- You can work or progress in stressful situations and cope with uncertainty, change, and performance demands. You manage your emotions to achieve goals, complete tasks, and control or direct behavior. You can revise plans in the face of obstacles, setbacks, new information, or mistakes. You adapt to changing conditions without stress.
Your Knowledge, Skills, & Abilities
- Ability to work well independently
- Skill in completing assignments accurately and with attention to detail
- Skill in focusing on quality, efficiency, and effectiveness
- Knowledge of computer systems and databases
- Knowledge of Microsoft Office and Google
- Skill in data entry with minimal errors
- Skill in collecting and analyzing complex data
- Ability to process information logically
- Ability to recognize, analyze, and solve a variety of problems
- Knowledge of generally accepted accounting procedures and principles
- Ability to review work for accuracy
What Else You Should Know
Mountain Home is an equal-opportunity employer and we value having staff who come from communities of diverse perspectives and have lived experience. We encourage people of color, indigenous folx, members of the LGBTQ community, and people with disabilities to apply.
All offers of employment at Mountain Home are contingent upon clear results of a thorough background check. The following factors will be considered for applicants with a criminal and/or less-than-ideal driving history:
- The nature of the conduct/behavior and its relationship to the position
- The recency of and circumstances surrounding the conduct/behavior
- The age of an individual at the time of the conduct/behavior
- Societal/cultural conditions that may have contributed to the conduct/behavior
- The probability that an individual will continue the conduct/behavior
- The individual's commitment to rehabilitation and changing the behavior