Medical Biller And Scheduler

Job description

Overview

Skyward Spectrum is an Applied Behavior Analysis (ABA) therapy agency in Georgia. We are seeking a billing and scheduling manager to carry out day-to-day revenue cycle management and appointment scheduling responsibilities.

This position will work directly with the Clinical Director and carry out all tasks related to revenue cycle function, providing analysis, and scrubbing outstanding claims.

To succeed in this role, you will need to have a thorough grasp of both billing and clinical operation requirements.

Please note that this job description is not all-inclusive and is subject to change. You may be asked to perform tasks or duties beyond what is written here.

Responsibilities:

1. Billing and Claims Management:

• Enter billing-related notes accurately into the system.
• Conduct thorough reviews of sessions and claims before submission to ensure accuracy.
• Review and update practice management software, including adding treatment authorizations and relevant information.
• Prepare and submit claims through electronic billing systems.
• Address claim rejections and work towards remediation.

2. Insurance and Payer Management:

• Submit, follow up on, and ensure the completion of treatment authorizations.
• Maintain up-to-date knowledge of payer requirements and stay current with changes in policies and procedures.
• Obtain notifications of benefits from insurance companies.
• Contract with new payers and manage the process of credentialing providers.
• Explain benefits and coverage details to clients, addressing any inquiries or concerns.

3. Financial Management:

• Invoice clients for copayments or private pay sessions.
• Monitor and manage the office budget, ensuring accurate financial record-keeping.
• Deposit checks and reconcile payments as necessary.

4. Administrative and Reporting Responsibilities:

• Facilitate and oversee the process of updating credentials, licenses, and certifications for clinicians as needed.
• Generate and provide reports on staff and client cancellations to support decision-making and resource allocation.
• Notify clinicians of upcoming expiration dates for treatment authorizations.
• Track and ensure the submission of accurate time sheets for proper reimbursement.
• Keep record of monthly RBT supervision and keep providers on track to reaching BACB requirements.
• Maintain manuals with updated knowledge on different payer processes and requirements.

5. Compliance and Documentation:

• Safeguard patient confidentiality and adhere to HIPAA regulations throughout the billing process.
• Ensure compliance with payer regulations, policies, and billing requirements.
• Maintain accurate and organized documentation as per payer and regulatory guidelines.

6. Continuous Improvement and Communication:

• Identify areas for process improvement in billing and claims management.
• Communicate and educate clinicians on billing-related updates, requirements, and changes.
• Collaborate with relevant stakeholders to implement enhancements.

7. Scheduling:

• Create and maintain schedules for therapists.
• Ensure that scheduling follows the guidelines and requirements set by payers.
• Coordinate with clients and therapists to determine availability and preferences for therapy sessions.
• Communicate schedule changes promptly to therapists, clients, and other relevant stakeholders.
• Take into account factors such as travel time, therapist expertise, client needs, and client preferences when creating schedules.
• Address scheduling conflicts or issues that arise due to therapist availability, client preferences, or unexpected events.

Qualifications/Skills

• At least 3 year’s work experience in related roles in the field of ABA therapy
• Excellent Attention to Detail
• Administrative Experience
• High School Diploma or GED; Bachelor’s Degree preferred
• Microsoft Teams
• Superb written and verbal communication skills
• Proficiency in MS Word and Office
• Able to pass background check with drug screening and qualified to work in US

Our Values

• Tailoring services to the needs of each child
• High clinical standards
• Fostering the development and promotion of our staff
• Respecting each child for his or her individual strengths
• Giving every therapist both the space to be themselves, and the support to ensure their success
• Maintaining a positive and collaborative work environment
• Honesty and Integrity