Job and Technical Knowledge – Demonstrates a thorough understanding of billing policies, procedures, and guidelines, including Maryland Medicaid protocols. Executes billing tasks accurately and confidently with minimal supervision, maintaining a high level of integrity and professionalism.

Communication – Communicates effectively both in writing and verbally, ensuring clarity and understanding. Listens attentively and provides relevant feedback, asking questions as needed to gain full comprehension. Exhibits professionalism in interactions and uses excellent customer service skills, showing tact when making requests or offering feedback.

Problem Solving – Proactively anticipates potential issues and understands their impact on other departments. Gathers all necessary information before making decisions and is adaptable to shifting priorities and deadlines. Actively works to improve processes, eliminating inefficiencies, and takes decisive action even under pressure or tight timelines.

Attention to Detail – Maintains focus in a fast-paced, high-volume environment, adhering to detailed procedures and ensuring accuracy in claim submissions and reconciliations. Carefully inspects work for errors, holding oneself to a high standard of excellence.

Organizational Skills – Effectively manages multiple tasks and prioritizes efficiently. Organizes daily responsibilities for optimal productivity and ensures all communications are clear and well-organized, making it easy for recipients to understand.

Responsiveness to Requests – Responds to inquiries promptly and thoroughly, prioritizing tasks and ensuring all follow-up actions are completed.

Flexibility – Adaptable to new information and changing demands, able to shift focus and perform a variety of tasks with ease. Manages transitions between tasks effectively.

Informatics – Utilizes information technology, such as Electronic Medical Records (EMR), to perform essential job functions efficiently.

RESPONSIBILITIES

• Ensure timely and accurate submission of claims to insurance companies and other funding sources.

• Resolve billing discrepancies and address non-payment issues through payment reconciliation.

• Review and correct all claims on a daily basis prior to submission.

• Upload and assess EOBs, 277s, 835s, and 999s on a weekly basis.

• Reconcile claim batches and make necessary adjustments for resubmission each week.

• Communicate with ASO weekly to resolve and dispute claims that cannot be processed online or through the EMR system.

• Notify providers of insurance lapses, reinstatements, and authorization issues as they arise.

• Contact consumers regarding insurance lapses or issues via phone and in writing, and document appropriate warnings in the EMR system.

• Collaborate with the psychiatry department to address RxEM codes, as necessary.

• Manage and maintain consumer data and insurance information while adhering to all privacy protocols.

• Identify and report any unethical or fraudulent billing practices and follow the necessary procedures to resolve them.

• Update the location of services provided, as required.

• Maintain and update the billing matrix as needed.

• Conduct billing audits as needed.

• Process self-pay payments, as necessary.

• Obtain concurrent OMHC authorizations as required.

• Participate in supervision, meetings, and training sessions as necessary.

• Perform other related duties as assigned.

POSITION REQUIREMENTS

• At least one year of experience as a medical biller/coder.

• Familiarity with DSM and ICD coding systems.

• Comfortable using an EMR system and various databases.