Billing & Reimbursement Specialist - Hybrid Work

Pay Range: $23.13 - $29.23

This position is responsible for inputting and/or verifying service activity, including generation of bills through appropriate recording of payment. Responsible for staying current with and following guidelines set forth by Michigan Department of Health and Human Services, Michigan Legislature, Medicaid, Medicare, Blue Cross and other payers.

JOB DUTIES:

1. Data Entry and Data Processing
   Input of service data into the required clinical and accounting electronic systems so the agency can bill for service, submit required reports and services delivered to the State of Michigan, track staff productivity, etc.

Must be proficient and accurate in auditing and processing externally submitted claims from network providers for payment.

2. Billing of Services
   Responsible for generating and submitting bills/claims to payers and consumers.

Responsible for completing follow-up on rejections.

Responsible for posting/applying payments received from payers and consumers for service provided.

3. Verification of Data Integrity
   Must be able to verify consumer financial and insurance information accurately.

Responsible for insuring consumer electronic medical charts are set up correctly to bill the appropriately insurance policies.

Must understand and become familiar with the Behavioral Health reporting requirements and provider qualifications for providing and billing services on behalf West Michigan Community Health.

Must meet claims submission deadlines set within internal policies and external contracts.

Must work with MDHHS Liaison on Medicaid eligibly and other MDHHS/WMCMH shared workflows

4. Provider Enrollment

Must be able to complete provider enrollments for billable credentialed staff to the necessary insurance companies.

Must be or become knowledgeable with CPT and HCPCS codes and which services are billable for which providers to specific insurances.