Medical Billing Specialist

1.0 FTE/40 Hours per Week.

Position is hybrid and will have onsite responsibilities, but also have ability to work remotely.

The Medical Billing Specialist is responsible for all Fee-for-Service (FFS) patient accounts.  This includes timely billing of non-covered services, services covered by other health insurance, co-payments and deductibles.  The Medical Billing Specialist is also responsible for the collection and posting of all payments related to patient accounts. Additionally, the incumbent provides assistance to members with billing inquiries, complaints and compliments; and performs credentialing certification for GHC-SCW providers for billing purposes.    The Medical Billing Specialist is responsible for enrollment of uninsured individuals in the Community Care Program and students in the Madison College Student Health Services.  The Medical Billing Specialist works under the general supervision and guidance of the Medical Billing Supervisor.

The incumbent knows and abides by all Group Health Cooperative of South-Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision and Common Values (stated below) and is committed to promote these values in behavior and attitude. 

Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.

Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values:

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.

We are better together.

JOB SPECIFIC QUALIFICATIONS 

1. High school graduation or equivalent is required. 
2. A minimum of one (1) or more years of accounting/billing related experience is required.  Experience in insurance or medical billing is preferred but not required. 
3. Basic knowledge of or ability to learn reimbursement/insurance practices for medical care is required.
4. Basic knowledge of Coordination of Benefits rules and regulations pertaining to Medicare, duplicate health coverage, Medicaid and privately sponsored plans is preferred.
5. Knowledge of or ability to learn medical, legal and insurance terminology is required.  Knowledge of or ability to learn diagnostic and procedure codes, CPT-4, ICD–9 and ICD–10 coding is required.
6. Good written and verbal communication skills are required to research issues with members and outside providers.
7. Excellent customer service skills are required.  Ability to be culturally sensitive and to work with diverse populations is required.   Strong listening skills both on the telephone and in person. 
8. Good organizational skills are required, including the ability to organize a high volume of work effectively and meet multiple deadlines.
9. Ability to maintain patient and company confidentiality required. Knowledge of or ability to learn HIPAA requirements. 
10. Knowledge of and/or ability to learn and use computer based applications such as MS Office, word processing, database, email, calendar and electronic insurance and records systems.  Experience with EPIC is desirable.  Must type a minimum of 40 WPM with minimal errors. Ability to use a keyboard extensively is required.
11. Ability to analyze, calculate, plan, explain, investigate, and work independently is required.
12. Ability to adapt and adhere to workflow and department changes is required.
13. Ability to climb, stoop, kneel and crouch is required.  Ability to bend, reach, lift, pull, push and/or carry up to 10 pounds regularly and up to 50 pounds occasionally is required.   Ability to sit for prolonged periods of time is required.
14. Ability to file at various heights is required.  Ability to move and twist head is required.
15. Ability to manage a high volume of telephone calls is required. Ability to work in an office environment is required.
16. Ability to perform fingering and handling with one or both hands required.