Job Description

Job Description

Job Description

JOB TITLE: Billing & Enrollment Specialist

Fair Labor Standards Act (FLSA) Status: Non-Exempt
Reports to: Revenue Cycle Manger

JOB SUMMARY: The Billing & Enrollment Specialist will assume responsibility of Spectra's provider enrollment process in conjunction with its billing and revenue cycle. This position will work closely with Business Center staff to facilitate advanced aspects of medical and dental claim processing. They will also collaborate closely with Spectra Health's Compliance Officer, as required throughout the Credentialing and Privileging process. The Billing & Enrollment Specialist performs an integral role in Spectra's ability to carry out timely and accurate billing and enrollment processes. This position reports directly to the Revenue Cycle Manager.

ORGANIZATIONAL PHILOSOPHY:

• Privacy & confidentiality: Maintain strict adherence to privacy and confidentiality protocols, ensuring the protection of both patient and employee information in accordance with Spectra Health's policies.

• Champion organizational values: Promote and embody Spectra Health's core values of Compassion, Trust, Respect, Equity, and Inclusivity in all interactions and decision-making processes.

• Culture of safety: Foster a culture of safety; proactively addressing hazards, incidents, and security concerns while contributing to a positive and safe work environment for employees and patients.

• Teamwork & collaboration: Approach teamwork with a positive and collaborative mindset, building strong relationships across departments and sharing knowledge and experiences to enhance overall organizational effectiveness.

• Be part of the solution: Actively support organizational change, offering solutions, participating in leadership initiatives, and championing efforts that align with Spectra Health's evolving mission and goals.

• Patient-centered decision making: Prioritize the best interests of Spectra Health's patients, ensuring quality care and positive outcomes.

• Training & meetings: Complete mandatory training requirements and attend at least 80% of departmental meetings to stay informed and aligned with organizational goals and policies.

• Policy adherence & compliance champion: Strictly adhere to all Spectra Health policies and procedures, and act as a departmental advocate for Spectra Health's Compliance Program activities

ESSENTIAL JOB FUNCTIONS:

• Maintain Provider Enrollment with Insurance Payers
• Claims Management: including claims appeals for outstanding & denied claims relating to enrollment
• Maintain Claims clearinghouse, including reconciling claim submissions
• Correct claim submission errors
• Facilitation of insurance and patient payments
• Collect, post, and manage patient account payments
• Collect, post, and manage insurance and other 3rd party payments
• Manage specialty billing pertaining to outside lab and x-ray processing
• Adjust patient charges in relation to the sliding fee discount program and other programs, as needed
• Work closely with Spectra Health's Compliance Officer, as required during the credentialing and
• privileging process.
• Work closely and in conjunction with other Business Center staff
• Answer patient inquiries and handle patient correspondence pertaining to billing
• Remain sensitive, yet assertive when assisting patients
• Perform other duties as assigned

JOB QUALIFICATIONS:
Required:

• High school diploma or equivalent
• 2-3 Years experience in healthcare billing/coding
• Ability to multitask, prioritize, and manage time efficiently
• Self-motivated and self-directed; able to work both independently and in a team setting
• Strong customer service skills and proficient in resolving patient and payor queries and/or requests.
• Excellent verbal and written communication skills
• Working knowledge of federal billing regulations and payor requirements

Preferred:

• A Bachelor's degree in Medical Billing or another healthcare-related field
• Experience working with Provider Enrollment
• Epic experience

PHYSICAL REQUIREMENTS: The Billing & Enrollment Specialist is primarily a desk job that requires the
ability to sit for long periods of time (up to 8 hours) at a desk or workstation. Periodically, the position requires
lifting or carrying items that would be appropriate in an office environment, not more than 20lbs.
REMOTE WORK: The Billing & Enrollment Specialist position is eligible for full-time or hybrid remote
work. For more information about remote work, please see HR Policy 1.28 - Remote Work.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties,
or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may
change at any time with or without notice.

Spectra Health provides job opportunities, salaries and benefits, training, promotions, facilities, and other
conditions of employment without discrimination based on race, color, national origin, religion, sex, age,
disability, genetic information, or any other characteristic protected by federal or state laws. Spectra Health
does not retaliate against applicants, employees, or former employees for filing a charge or complaint of
discrimination, participating in a discrimination investigation or lawsuit, or opposing discrimination.

Job Tags

Similar Jobs