Billing Coordinator

DescriptionThe Billing Coordinator supervises the Billing Team, which is responsible for billing insurance claims to the Oregon Health Plan (OHP) Medicaid Open Card and Coordinated Care Organizations, as well as Medicare, commercial insurance, and private pay. The Coordinator oversees the claims processes of checking eligibility, submitting claims, processing payments, identifying billing discrepancies, resolving denials, and determining write-offs. The Coordinator is responsible for ensuring prior authorizations are in place and updating systems for fee schedule changes.Essential FunctionsBilling System Oversight (25%)Implement and maintain billing contracts with insurance companies in coordination with Practice ManagerLiaison with Oregon Health Plan regarding Vision Service rulesAttend insurance billing meetingsMaintain billing systems with current fee schedules, covered diagnoses, prior authorization requirements, and CPT/HCPCS procedure codesPrepare month-end reports of all claim batches submittedReconcile, maintain, and update billing denials listsIdentify areas of revenue leakage and propose corrective actionsImplement and maintain billing-related standard operating procedures (SOPs)Claims Processing (60%)Verify and update insurance eligibilityCommunicate changes in eligibility to appropriate staffContact providers for missing claims informationComplete billing, reconciling, researching, and re-billing tasks including contacting insurance companies and working towards a resolution for paymentReview insurance denials for patterns of denials and submit timely appeals and reconsiderationsProactively follow up on claims over 30 days outstandingMaintain claims over 60 days at less than 3% of total A/RUpdate billing systems with payment information and generate 2nd-payer claimsStaff Supervision (15%)Supervise Billing Team staff, including hiring and training, conducting annual performance appraisals, following policies and procedures, maintaining a healthy and safe working environment, and completing corrective actions including work plans and termination recommendationsAssign and/or delegate tasks to Billing SpecialistsOther FunctionsPrepare checks for depositOther administrative duties as assignedKnowledge And AbilitiesKnowledge of medical insurance claims billing, including Medicare and MedicaidAbility to communicate appropriately with staff and customersAbility to use professional judgement and make decisions based on information availableExcellent organizational and time-management skills, including the ability to manage workflow and prioritize tasks to meet deadlinesKnowledge of HIPAA confidentiality requirements as they relate to health care and personal health informationAccurate data entry, including high attention to detail and the ability to self-monitor for errorsAbility to concentrate on repetitive tasks and maintain attention to detailAbility to use a computer and e-mail for documentation and communication Ability to use standard office equipment and software programsAbility to work independently, including prioritizing tasks and monitoring errorsAbility to remain in compliance with policies, procedures, regulations, and standardsAbility to meet Universal Expectations of EmploymentAbility to perform physical requirements of the position, including lifting up to 25 pounds, standing, sitting, bending, kneeling, crouching, reaching, grasping, using fingers, speaking, repetitive motion, extensive use of computerMinimum Requirements3 years’ experience in medical claims billing, including payment analysis, research, denial resolution, and collectionsDocumentation of successful completion of a background and fingerprint check as specified by Oregon law, as well as a urinalysis drug screenPreferredExperience with Medicaid/OHP benefitsExperience in supervising staff or in a leadership roleRequirements3 years’ experience in medical claims billing, including payment analysis, research, denial resolution, and collectionsDocumentation of successful completion of a background and fingerprint check as specified by Oregon law.Drug Screening RequirementSuccessful candidates must complete and maintain compliance with Laurel Hill Center’s drug-free workplace standards, which include:Passing a urinalysis drug screening with a negative result for THCOngoing compliance with agency drug testing policies, as applicableWhile marijuana is legal under Oregon state law, this requirement is based on Laurel Hill Center’s contractual, regulatory, and funding obligations, which mandate adherence to drug-free workplace standards for certain positions.Failure to meet or maintain these requirements may impact employment eligibility.PreferredExperience with Medicaid/OHP benefitsExperience in supervising staff or in a leadership role