Job Description

Position Description:

Individuals in this position are responsible for overseeing the billing process cycle to include eligibility checks, ensuring claim accuracy, claim processing, claim correction and resubmission, and posting reimbursements. Individual will assist Insurance Network Coordinator as necessary.

Position Expectation:

In keeping with the mission and core values of Tri-County Human Services, all persons served, stakeholders, and fellow employees will be treated with dignity, respect, and shown sensitivity to their cultural diversity.

Primary Duties and Responsibilities

• Performs billing of insurance services claims.
• Reviews services claims for compliance prior to submitting claims for payment.
• Conducts person served insurance eligibility checks and verifies insurance authorizations.
• Performs follow-up process to ensure all insurance claim reimbursements are received.
• Provides claims reports to programs by funding source.
• Answers telephone calls and routes as appropriate, types reports, correspondence, and other items as requested by supervisory staff.
• Assists in training new staff.
• Assists in preparing contract renewals.
• Assists Network Insurance Coordinator with updates and processing staff rosters for insurance panels.
• Attends insurance company billing update training when Network Insurance Coordinator is unavailable.
• Position qualifies for short-term telecommute per policy 100.027 – Telecommuting Guidelines.
• Performs other reasonable and related duties as assigned.

Minimum Training and Experience

• Certificate in billing, insurance verification or a closely related course of study, from an accredited institution of higher learning or two (2) years of post-high school education in the study of a related field or other approved course of study, or three (3) years of full-time professional experience in a position which utilized the skills/knowledge acquired during the aforementioned course of study. Individual must be able to demonstrate proficiency of learned or acquired skills. Incumbent must be a self-starter individual with the ability to make proper informed decision with the guidance of management.
• Requires the ability to work independently, be detail oriented, make appropriate decisions and to consistently exercise discretion and independent judgment. Maintains a courteous, helpful, and professional behavior on the job. Displays a willingness and ability to be responsive to all programs in problem solving activities.

Tri-County Human Services, Inc. is an equal opportunity employer. M/F

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