Under the direction of the Billing Supervisor/Manager, the Billing Specialist I performs all billing, editing and research functions to process claim submissions. The billing specialist works collaboratively with other departments including but not limited to revenue cycle, claims and member services. The billing specialist is primarily responsible for accurate and timely claim submission to internal and external payors adhering to government regulations and payor specific policies, ensring proper account documentation is maintained in the system of record to support all billing activities.

• Works daily electronic/manual work list by researching and resolving claims edits, performing claim corrections by accessing supplemental system such as Bedrock, foundations, ePremis and others.


• Validates Insurance information (using system such as Passport, DDE and CWF), review eligibiilty and ensure correct coverage is attached to the claim.


• Reviews, prints and submits paper claims to payors that do not accept electronic claims or require special handling


• Processes claim attachments in support of billing requirements by payor


• Monitors for trends and issues within scope of work, reports findings to lead biller and/or manager.


• Participates and attends meetings, training seminars and in-services to develop knowledge and keep abreast of payor requirements and regulatory changes.


• Assists in reviewing and/9r resolving credit balances


• Documents required information and account notes in the system of record in a timely and accurate manner.


• Confidentiality/Security of Systems: Maintains and complies with policies and procedures for confidentiality of all patient records.


• Demonstrates knowledge of privacy, and security of systems and associated policies and proceduers for maintaining the security of the data contained within the systems.


• Other duties: Performs other duties as assigned within the job function.


• To perform these essential duties, an individual should independently demonstrate the following competencies:


• Analytical -Collects and researches data; uses experience to compliment data and develops trend analysis


• Problem Solving- identifies, escalates and resolves problems in a timely manner. Able to follow directions as given by lead/supervisor/manager.


• Customer Service- In all interactions with patients, members, physicians, staff and visitors, demonstrates service-oriented behaviors, Demonstrates openness to creative and innovative approaches to providing service


• Interpersonal Skills- Maintains confidentiality; ability to communicate and deal effectively and professionally with a diverse group of internal and external customers.


• Oral Communication- Listens and gets clarification to ensure that instructions and requests are fully understood.


• Written Communication- Reads and interprets written information with ability to clearly communicate in written formats.