BROWNSVILLE COMMUNITY HEALTH CENTER · 21 hours ago
Senior Billing Specialist
Brownsville, TX
Full-time
Onsite
Senior Level
5+ years expNew Horizon Health Center is a Federally Qualified Health Center dedicated to delivering quality healthcare services to the community. The Senior Billing Specialist will manage billing workflows, mentor staff, and ensure accurate and timely claim submission while collaborating with a multidisciplinary team to support patient-centered care.
Hospitals and Health Care
Responsibilities
Ensures all charges and adjustments are completed
Enter charges and perform adjustments in the subsidiary ledger utilizing the Electronic (EHR) Manual Charge Processing Pending Report after providers have finalized the office visit note in the EHR
Verifies the diagnosis code (ICD-10) and Current Procedural Terminology (CPT) codes correlate
Communicate with nursing and providers regarding coding discrepancies
Verify and update patient demographic data during the 'Check-Out' process
Communicate the financial obligation for services rendered to the patient
Post payment and adjustments if applicable into the (EPM)
Discuss and document payment arrangements in the EPM if the patient cannot pay for the office visit on the date of service
Oversee and guide a team of medical billers handling various claims
Submit and track clean claims to Medicare, Medicaid, and multiple commercial payers
Manage claim denials, appeals, and underpayments to maximize reimbursement
Ensure compliance with payer rules, lab-specific modifiers (QW, 91, 59), and CMS regulations
Lead training and onboarding for new staff and maintain internal billing SOPs
Monitor team KPIs and generate reports for leadership and clients
Act as a point of contact for billing escalations and process improvements
Collaborate with coding, compliance, and client services teams
Verify insurance medical coverage and benefits
Process insurance claims and verify claim submission
Review ERA’s and Explanation of Benefits prior to posting payments for accuracy of reimbursement from insurance companies
Accurately post and balance payment amounts to EPM (Practice Management) within the allotted time and deposits all monies collected
Review Account/Receivable Report and follow-up on unpaid claims. (i.e., denials, unpaid claims over 30 days, etc…)
Review negative account balances and process accordingly
Run daily reports required to perform job duties
Balance daily account financial transactions. Daily submit payments received from patients to the designated employee in the Finance Department
Answers questions and/or assists the public on insurance and personal account related matters
Responsible for credentialing/enrolling and re-credentialing of all providers and clinic sites promptly with all governmental and commercial third-party payers (i.e., Medicare, Medicaid, etc.)
Works closely with the Medical Director’s Assistant to obtain the provider credential documentation
Obtain the NPI numbers from the NPI system for each provider and clinic site
Acquire login, create and maintain data for each provider electronic CAQH application
Completes and submits paperwork to enroll providers and clinic sites in the Medicare Program using PECOS
Completes and submits paperwork to enroll providers and clinic sites in the Medicaid Program using the TMHP website
Maintain and keep current Pharmacist in Charge License, DEA for pharmacy, State Rx License, NCPCP Rx Portal
Keeps current with all insurance changes and submits all initial and reapplication for all providers and clinic sites as required
Completes and submits paperwork to enroll providers and clinic sites with the Third-Party Insurance Payers
Maintains a tickler system to organize and prioritize upcoming deadlines and follow though until completion
Maintains a filing system for easy retrieval of agreements, applications and documents pertinent to credentialing and recredentialing for each medical provider and clinic site
Immediately updates Medical Billing Manager of any errors or interruptions with credentialing and re-credentialing or as needed
Notifies appropriate staff when providers have been placed in network within 3 days of receipt of notification
Notify payers of all providers who have termed with the health center within a week from termination
Must attentively greet and be responsive to patients, general public, and employees whether it be in person or over the telephone by demonstrating professionalism, a positive attitude, good eye contact, and a pleasant voice
Demonstrated proficiency in medical terminology, collections, and reimbursement processes
Strong communication skills, including the ability to effectively communicate with patients, providers, and insurance payers
Experience with medical billing software and electronic health records systems
Cross-Train among other departmental job duties
Miscellaneous and clerical duties and other as required
Must always maintain confidentiality according to Center policies and HIPAA rules
Must abide by dress code policy in order to maintain a professional and neat appearance. (For details see Employee Handbook dress code policy)
Abides by the regulations, protocols, and policies as indicated in the BCHC Employee Handbook, Safety policies and Code of Conduct
It is mandatory that the employees actively participate in Performance Improvement Program
Qualification
Required
High School Diploma or GED
Completion of a Medical Office /Coding program required
Fluent in medical billing terminology
Must have a valid Driver's License May travel from site to site
5+ years of extensive experience in medical billing, accounts receivable, or revenue cycle management in a medical setting
2-3 + years experience with facility and provider credentialing, collections, and denial management
2+ years in a supervisory or lead role within revenue cycle or billing operations
Familiarity with billing software and clearinghouses
Strong organizational, leadership, and communication skills
Valid driver's license required
Excellent Customer Service Skills - Good interpersonal skills, capable to maintain calm under stress, courteous and respectful demeanor
Excellent organizational skills, attention to detail and follow-through
Verbal ability is required to understand written records pertaining to center charges and to discuss them with the patients
Ability to read and understand medical terminology, to read and understand written reports and to abstract pertinent information from records
Numerical ability is required to compile, interpret and utilize reports
Knowledge of general office procedures
Keyboarding and 10 key calculator
Ability to communicate orally and in writing in English and Spanish
Ability to establish and carry out specific courses of action
Ability to take corrective action in solving problems, to identify dimensions of a problem, determines potential causes and specifies alternative solutions
Ability to conform to the Center's established policies and procedures
Ability to maintain a mature attitude while dealing with interpersonal conflict, disruptions, time demands
Preferred
3+ years in coding (preferred) extensive experience and knowledge of CPT and ICD-10 requirements, coding, billing guidelines, and industry regulations
Medical billing and or Coding certification (CPB, CMRS, CPC) preferred but not required
Company
BROWNSVILLE COMMUNITY HEALTH CENTER
BROWNSVILLE COMMUNITY HEALTH CENTER is a medical practice company based out of 191 E PRICE RD, Brownsville, Texas, United States.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase