CLUES Hiring For Third Party Billing Specialist (bilingual Eng-Span) at Saint Paul, MN  Full Time

POSITION SUMMARY

CLUES’ Certified Community Behavioral Health Clinic (CCBHC), Abriendo Caminos, will be providing immediate access to supportive, high-quality, culturally-responsive and integrated Behavioral Health services and pathways to wellness for the Latino Community, regardless of insurance status or ability to pay. The CCBHC model provides CLUES with a model for sustainable Behavioral Health service provision, which translates to increased access to consistent care for wellness in the Latino community. 

The Third-Party Billing Specialist is responsible for the coordination of 3rd party billing within the Accounting Department for Behavioral Health services; managing all aspects of the Revenue Cycle, coordinating all aspects of the Credible Billing Program, working closely with department providers, the Behavioral Health 3rd Party billing clearing house, Availity, and clients to maximize captured billable hours and payments received; and supporting the operations of the Accounting Department.

The Third-Party Billing Specialist is also responsible for the coordination of billing for Adult Rehabilitative Mental Health Services (ARHMS), as well as Adult and Children’s Mental Health Targeted Case Management (TCM) services, in collaboration with Behavioral Health leadership staff.

In addition, this position will be responsible for ensuring accounting month-end close of activities are in compliance with requirements provided by Government entities and CLUES Senior Management.

Department: Administration – Finance/Accounting
Reports to: Behavioral Health Compliance Manager 
Location: CLUES St. Paul and Minneapolis, MN Offices
Position Type: Regular
Schedule: Full-Time. Generally, Monday – Friday Office hours.
Estimated Pay: $20.68 to $23.56 (depending on experience & qualifications).
Benefits: Full benefits package available in accordance with current CLUES policies—includes: medical, dental, vision, critical illness, accident, and life insurance (with AD&D); long term and short-term disability; pre-paid legal services and ID theft protection; retirement plan; educational assistance; paid holidays; and paid time off.
 

ESSENTIAL DUTIES AND RESPONSIBILITIES

Coordinate 3rd Party Billing Revenue Cycle in Credible

• Run service lines, send claims for all payers, follow-up to make sure that service lines were accepted, create adjustments & charges for client responsibilities, and post all payments to Credible & Accounting reports.
• Investigate rejected claims/unpaid denials on a regular basis, correct and resubmit any service lines/claims by working with department leadership, the Behavioral Health 3rd party billing clearing house, Availity, and/or payers and follow-up to ensure payment.
• Receive payments (i.e., Bremer Direct Deposit monitoring, checks, & ERA’s).
• Coordinate with Mental Health and Chemical Health leadership to ensure that data is entered correctly, accurately and that everything is complete in order to receive prompt and correct payments.
• Participate in billing meetings and follow up with staff on issues discussed, etc.
• Identify and recommend process improvements to create efficiency in billing and maximize billable hours captured and entered.
• Work with appropriate department contacts to coordinate Credible billing for Behavioral Health:
  1. Keep payers updated with the newest rates (standard for CLUES but also taking into account updates on contracted rates, etc.) and correct Diagnosis/CPT codes
  2. Create new payers when needed and add the correct CPT codes to the payers for billing purposes
  3. Update and keep current a Credible “cheat sheet” to help providers when entering service lines
• Keep current on medical coding as applicable to CLUES (including any Diagnosis Code or Billing Code Mandates).
• Collaborate with Behavioral Health leadership, the Department of Human Resources, and County leadership on monthly billing for ARMHS and Adult and Child TCM. Collaborate with accounts receivable to ensure proper allocation of payments.

Complete Reporting

• Compile monthly reports on billable hours vs. payments received using Credible & Accounting reports.
• Facilitate accurate reporting from Credible by cleaning-up Credible balances that are considered old and/or un-paid according to the standards of the accounting department.
  • Monthly clean-up involves the correct write-off of old, unpaid balances and the noting of unpaid balances in Credible (to show which clients have balances which must be paid in full before beginning new services).

Act as Internal Point of Contact for Department Leadership

• Be the go-to person for billing items in Credible for department leadership with billing or service line questions.
• Follow-up on treatment authorizations:
  • Act as the go-to person for department leadership when assistance is needed regarding authorizations. 
  • Follow-up with assessors, counselors, and insurances to make sure the authorization is in Credible and ready for billing purposes. 
  • Communicate with Service Response/providers to obtain additional information when necessary. 

Manage Collection of Client Payments

• Deliver world-class customer service in line with CLUES mission and operating values.
• Send out statements on a regular basis and act as main point of contact for clients who want to discuss their statements.
• Conduct collections activities such as making phone calls to clients with outstanding balances to try to establish payment plans.

Support Accounting Department Operations

• Run reporting as assigned.
• Reconcile Credible to the general ledger / financial statements on a monthly basis.
• Reconcile the bank reconciliation as needed.
• Provide back-up coverage for accounts payable, accounts receivable, payroll and other accounting processes as needed. Provide assistance with the implementation of new accounting upgrades, such as with accounts receivable, bank reconciliation, and payroll upgrades.
• Assist with year-end accounting work and audit preparations.

General Duties

• Maintain patient confidentiality in accordance with HIPAA standards and industry best-practice, agency policies and other applicable laws, regulations and ethical standards.
• Promote the mission, operating values, and agency services of CLUES within the community. 
• Carry out all other duties as assigned by supervisor.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  Other duties or tasks may be assigned as required. Management may modify, change or add to the duties of this description at any time without advance notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

SUPERVISORY RELATIONSHIPS

• This position has no supervisory responsibilities.

QUALIFICATION REQUIREMENTS

Education, Experience & Key Abilities 

• Associate degree in accounting or related field required. Bachelor’s degree in accounting or related field preferred.
• At least 1-2 years of accounting experience including billing/invoicing required. Nonprofit accounting experience preferred. Experience preparing & processing invoices for a wide range of Government types (Local, City, State and Federal agencies) strongly desired.
• Familiarity working with ERP systems (such as NetSuite) and EHR systems such as Credible a plus preferred.
• Strong attention to detail and ability to ensure that outgoing information is thorough and accurate.
• Must possess strong interpersonal skills, speaking and writing skills, and the ability to interact in a positive manner with others. Must collaborate effectively with co-workers and key stakeholders as a “team player”.

Language Skills

• Effective communication in Spanish and English, both verbally and in writing, required.
• Ability to read, analyze, and interpret written materials, including reports, contracts, and proposals. 
• Ability to effectively present ideas and information in an organized and effective manner, including writing reports.
• Ability to maintain accurate documentation and respond appropriately to questions from clients, co-workers, management and external parties. 

Computer Skills

• Proficient working knowledge of email software, the Internet, databases, and common Windows-based programs, including Microsoft Office Word, Excel and PowerPoint required. 
• Must be willing to attend training to advance technical skills and maintain appropriate skill levels to perform job duties.

WORKING CONDITIONS

Background check

• Must pass a criminal background check. As a condition of continued employment, staff person may be required to submit to periodic re-verification of these background checks.

ABOUT US

Comunidades Latinas Unidas En Servicio (CLUES) is a non-profit leader in behavioral health and human services. The organization was founded in 1981 with a vision for improving the quality of life of the Latino population in Minnesota. Today, CLUES is Minnesota’s largest Latino agency. Our mission is to advance the capacity of Latino families to be healthy, prosperous, and engaged in their communities. Although our services focus on the Latino family, our experience and capabilities enable us to serve individuals and families from all walks of life including new immigrants and low-income families who dream of a better future.  By focusing our efforts in the areas of Health and Family Well-being, Economic Vitality, Educational Achievement, and Civic and Cultural Engagement, our programs are designed to empower Latinos and immigrants by meeting them where they are, harnessing their strengths, and honing their skills. CLUES employs a diverse, multi-cultural staff to ensure our services are linguistically and culturally relevant.

Note: As a federal contractor, CLUES is preparing for a potential requirement that employees be vaccinated against COVID-19 unless they have a medical or religious exemption. At the time of an employment offer, we will request proof of vaccination status or provide the process/forms for medical 
or religious accommodation.