Insurance Billing Coordinator

Job DetailsJob Location: Premarq 204 - Warrenton, OR 97146Salary Range: $23.67 - $30.89 HourlyClatsop Behavioral Healthcare (CBH) has moved most positions to a 4 day 9 hour work week with paid 30 minute lunches to promote a better work life balance. Wages have also been increased for our valued current and future employees. Clatsop Behavioral Healthcare has an immediate opening for a full time Insurance Billing Coordinator. This position ensures CBH receives timely and accurate reimbursement for services rendered while maintaining compliance with payer contracts, reimbursement requirements, applicable laws, regulations, and agency policies. This position is responsible for managing accounts receivable activities, resolving claim denials, securing reimbursement, and supporting all aspects of the revenue cycle. Services are billed to a variety of funding sources, including Medicaid, managed care organizations, contracted payers, commercial insurers, guarantors, and self-pay clients. This is a remote position, but employees must reside in Oregon or Washington.  Essential Functions/Major Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Verify and maintain client insurance eligibility, coverage, benefits, and payer information to support accurate billing and reimbursement. Review, investigate, and resolve billing, claim, authorization, and documentation issues that prevent successful claim generation or submission. Maintain billing-related system configuration, including fee schedules, payer settings, procedure codes, billing rules, and other authorized revenue cycle components. Generate, review, validate, and submit electronic and manual claims to Medicaid, managed care organizations, commercial insurers, contracted payers, and other funding sources. Monitor claim status through the electronic health record, clearinghouse, and payer systems; investigate and resolve claim rejections, denials, and other reimbursement barriers. Process, reconcile, and maintain electronic and manual payment transactions, including payment posting, adjustments, transfers, refunds, recoupments, and account corrections. Review explanation of benefits (EOB), remittance advice, and electronic payment transactions to ensure accurate reimbursement, account reconciliation, and financial reporting. Generate, review, and process client statements and account balances, ensuring accurate billing and timely communication regarding financial responsibility. Monitor accounts receivable, analyze aging reports, investigate outstanding balances, and pursue appropriate follow-up actions to maximize reimbursement and reduce outstanding receivables. Process approved account adjustments and write-offs in accordance with organizational policies, contractual obligations, and regulatory requirements. Assist clients with resolving outstanding account balances by explaining financial responsibility, establishing payment plans, processing sliding fee scale and grant assistance applications, identifying available funding resources, and coordinating collection activities in accordance with agency policies and applicable regulations. Verify, document, and monitor insurance authorizations and service limits to support compliant billing and reimbursement practices. Review employee credentialing status and coordinate with Human Resources regarding credentialing and recredentialing requirements that impact billing eligibility. Maintain, reconcile, and apply grant-funded payments and other non-insurance reimbursement sources to client accounts. Generate and analyze operational, billing, reimbursement, authorization, and accounts receivable reports to support revenue cycle performance and compliance activities. Respond to inquiries from clients, payers, providers, auditors, and agency staff regarding billing, reimbursement, claims, authorizations, and account balances. Maintain compliance with federal and state regulations, Oregon Health Authority requirements, payer contracts, HIPAA standards, and agency policies related to billing and reimbursement. Participate in training and professional development activities related to revenue cycle operations, healthcare reimbursement, billing systems, and regulatory changes. Fulfill mandatory abuse reporting responsibilities in accordance with Oregon law and agency policy. Perform other duties as assigned   Education/Experience Requirements: High school diploma or equivalent required. Three (3) years of progressively responsible experience in healthcare billing, medical claims processing, accounts receivable, revenue cycle management, accounting support, or a closely related field; or an equivalent combination of education, training, and experience. Experience utilizing electronic health records (EHR/EMR), billing software, clearinghouse systems, and Microsoft Office applications. Knowledge of healthcare reimbursement methodologies, claim submission processes, payment posting, denial management, collections, and accounts receivable functions. Ability to interpret and apply federal and state regulations, payer requirements, contracts, and organizational policies related to healthcare billing and reimbursement. Knowledge of the Health Insurance Portability and Accountability Act (HIPAA) and the ability to maintain confidentiality of protected health information. Demonstrated ability to communicate effectively with clients, insurance representatives, providers, and coworkers while maintaining professionalism and positive working relationships. Ability to successfully complete and maintain eligibility under criminal records check requirements in accordance with Oregon Health Authority regulations, Medicaid requirements, and agency policy. Possess and maintain a valid Oregon or Washington Driver License and meet the agency's insurance requirements. Ability to travel to agency locations for meetings, training, and other business purposes as required. Preferred Associate degree in Accounting, Business Administration, Healthcare Administration, Medical Billing and Coding, or a related field. Certified Professional Biller (CPB), Certified Professional Coder (CPC), or other relevant healthcare billing and coding certification. Experience working with Medicaid, Medicare, managed care organizations, commercial insurance carriers, and client accounts. Knowledge of Oregon Health Authority (OHA) requirements, Oregon Administrative Rules (OARs), Medicaid/Oregon Health Plan (OHP) billing requirements, and behavioral health reimbursement practices.   The above statements are not intended to be an exhaustive list of all responsibilities, duties and skills. CBH offers an exceptional BENEFIT package. For full time employees, benefits include: Medical (minimal premium cost to employee), Dental (Employer Paid), Vision (employer paid), 403(b) Retirement (fully vested 5% employer contribution after 1 year of employment), Life Insurance (Employer Paid), Short-term Disability (Employer Paid), and Employee Assistance Program. Dependents covered on medical, dental and vision at cost to employee. 12 paid holidays and 6.77 hours of PTO accrued for years 1-3, increases after year 3. PTO accumulation starts at hire and is available for use as accumulated. Employees are eligible for elective training reimbursement of ($1000/yr for unlicensed clinicians and $1500/yr for licensed clinicians.) CBH also offers sabbatical of 176 hours after 10 years of service and annual elective training fund that includes 40 paid hours for training. Supervision towards licensure available. Salary DOE Clatsop Behavioral Healthcare values the diversity of the people it hires and serves. CBH is an equal opportunity employer. CBH uses E-Verify to confirm the identity and employment eligibility of all new hires.