BILLING SPECIALIST
ABOUT IMPACT HEALTH
Impact Health is an Asheville-based nonprofit leading Western North Carolina’s participation in North Carolina’s Healthy Opportunities Pilot. HOP is a groundbreaking initiative that uses Medicaid funding to support social drivers of health across four key domains: food, housing, transportation, and interpersonal safety and toxic stress. The pilot’s aim is to improve health outcomes for NC Medicaid members who could benefit most while reducing overall healthcare costs.
Impact Health supports a network of more than 50 human service organizations (HSOs) by
- Serving as a bridge between the state, private health plans, care managers and other HSOs.
- Building organizational capacity through financial support, training, and technical assistance.
- Assisting with Medicaid billing, data collection and evaluation efforts.
- Convening pilot entities to share best practices.
Impact Health is committed to improving the wellbeing of all those living in WNC by connecting community-based organizations and healthcare systems to ensure equitable, inclusive whole-person care.
SUMMARY
The Billing Specialist, reporting to the Billing Manager, is responsible for assisting with executing the billing operations for a network of HSOs (human service organizations) within the Healthy Opportunities Pilot program (HOP). This position is responsible for supporting the submission of approved invoices to PHPs (Prepaid Health Plans) from HSOs, assisting in the development, implementation, and documentation of policies and procedures related to billing, providing timely and accurate billing of services, and providing exceptional levels of customer service to both internal staff and external stakeholders.
ESSENTIAL JOB FUNCTIONS
- Review and approve invoices received from HSOs.
- Identifies and resolves billing issues that result in a rejected invoice.
- Provide timely delivery of billing and payment processing, including the submission of accurate invoices to PHPs from HSOs for service delivery.
- Adhere to existing billing systems and assist and inform on any changes throughout the program.
- Work with Community Engagement Managers and HSOs to coordinate processes around service delivery in relationship to invoicing.
- Assist in the quality assurance processes.
- Provide additional training and Technical Assistance (TA) to the HSO related to the pilot program’s billing when accuracy and completeness issues are identified.
- Be familiar with all service delivery methods billable through HOP.
- Complete training in NCCARE360, NCTRACKS, and other training as identified by HOP.
- Adheres to all HIPPAA guidelines/regulations.
QUALIFICATIONS
Education
- Associate degree required and 4 years work-related experience in health care administration, finance, or insurance customer services, claims, or billing; or
- Bachelor's degree and 2 years work-related experience in health care administration, finance, insurance customer services, or claims and billing.
- Bachelor degree and 2 years work-related experience in health care administration, finance, insurance customer services, or claims and billing.
Experience
- Medical or healthcare billing, with claims processing experience required.
- Medicaid managed care experience with a plus.
- Experience working with multiple entities in a billing setting.
- Medical office experience with insurance a plus.
- Knowledge of HIPPA rules and regulations.
- Knowledge of insurance guidelines, especially Medicaid.
- Proficient with computers and other office equipment, including experience with web-based databases, and all Microsoft Office programs.
Skills and Attributes
- High degree of accuracy, ownership, and attention to detail.
- Commitment to excellent customer service.
- Ability to work successfully both independently and as part of a team. Anticipate, understand, and respond to the needs of internal and external clients to meet or exceed their expectations within the organizational parameters.
- Strong and proactive problem-solving skills. Assess problem situations to identify causes, gather and process relevant information, generate viable solutions, and make recommendations and/or resolve the problem.
- Commitment to deadlines.
- Ability to manage multiple projects simultaneously.
- Demonstrate a willingness to be flexible, versatile and/or tolerant in a changing work environment while maintaining effectiveness and efficiency.
- Speak, listen, and write in a clear, thorough, and timely manner using appropriate and effective communication tools and techniques.
- Supports equitable treatment and equal opportunity for all employees and an environment of learning about, valuing, encouraging, and supporting differences.
ESSENTIAL PHYSICAL SKILLS
This position requires frequent sitting, standing and occasional walking; occasionally lifts objects weighing up to 10 pounds. This position requires manual dexterity sufficient to operate phones, computers, and other office equipment. This position requires the visual ability to work in front of a computer screen for prolonged periods of time. This person must speak clearly using the English language to accurately convey information and be able to hear at normal speaking levels both in person and over the telephone. The employee must be able to receive and understand written and oral communication and give written and oral instructions.
ENVIRONMENTAL CONDITIONS
This position can be hybrid, working in a home/office environment with occasional visits to external sites that require driving to and from various locations. Applicants must be committed to living within, and performing hybrid work from, the 18-county region we serve.