Reimbursement Specialist

General Summary

This position performs a variety of accounting-related functions related to finance and billing.  

This position reports to: Accounting and Billing Supervisor 

 

Essential Functions

 

• Account Clerk/ Accounts Payable:  

A. Essential Functions

1. Organizes, reviews, prepares, and maintains all bills for accounts payable and agency Audit Committee process.
2. Maintains communication and correspondence with Lapeer County Finance Department regarding accounts payable function.
3. Prepare cash deposits as necessary. 
4. Responsible for agency petty cash.
5. Responsible for coffee fund money and deposits.
6. Posts audit related information into the computer.
7. Prepares audit report, including payroll report and trial balance
8. Generates reports for staff or providers as needed
9. Participates in agency committees as directed

 

B. Other Functions:

1. Entry and maintenance of locations in EMR
2. Maintain and update rate schedules as needed in EMR
3. Other duties as assigned in a positive, cooperative manner

 

• Account Clerk / Reimbursement Specialist:

A. Essential Functions:

1. Prepares and submits third-party billings, secondary payer and COFR payers for all services through appropriate guidelines of insurance payers.
2. Posts third party and other billing payments received.
3. Follows up and resubmits rejected and pended third party billings.
4. Assists in completion of provider enrollment forms for public and private insurances.
5. Generate reports for staff or providers as needed 
6. Participates in agency committees as directed

                                                                                                                                  

B. Other Functions:

1. Entry and maintenance of direct run locations in EMR
2. Maintain and update rate schedules as needed in EMR
3. Other duties as assigned in a positive, cooperative manner
4. Lapeer County Community Mental Health embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence.  An employee with this or any position is expected to support the employment environment.

 

• Account Clerk / Finance Support Specialist:

A. Essential Functions:

1. Gathers initial demographic and financial information to conduct ability to pay (ATP) determinations.
2. Provides annual ability to pay redeterminations.
3. Generates monthly ATP billing statements to consumers. 
4. Conducts monthly reviews of Medicaid spend downs
5. Update and maintain agency General Fund List
6. Generate reports for staff or providers as needed 
7. Participates in agency committees as directed

 

B. Other Functions:

1. Maintain and update rate schedules as needed in the EMR.
2. Other duties as assigned in a positive, cooperative manner
3. Lapeer County Community Mental Health embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence.  An employee with this or any position is expected to support the employment environment.

 

• Account Clerk / Claims Specialist:

A. Essential Functions:

1. Conducts monthly ASAP personal care billings.
2. Processes monthly claims from contracted residential services providers.
3. Processes monthly claims from inpatient hospitalizations.
4. Processes monthly claims from all agency contracted providers, including COFR claims from other counties.
5. Data verification for all provider claims.
6. Complete and process data errors related to claims data.
7. Participates in agency committees as directed

 

B. Other Functions:

1. Train contract providers to utilize the electronic medical record (EMR) for claims entry and submission.
2. Entry and maintenance of provider locations in EMR
3. Maintain and update rate schedules as needed for contract services in EMR.
4. Verify and update rate setting queue for service authorizations on residential services in the EMR.
5. Other duties as assigned in a positive, cooperative manner 

                                                                                                                                        

Other Functions

Provide support to finance account clerk positions as necessary.  Lapeer County Community Mental Health embraces an employment environment that promotes recovery and discovery, a person-centered approach to treatment/services, and cultural competence.  An employee with this or any position is expected to support the employment environment.

 

This list may not be inclusive of the total scope of job functions to be performed. Duties and responsibilities may be added, deleted or modified at any time.

Qualifications

Employment Qualifications

 

Education:  High school graduation or equivalent.  Advanced course work in accounting or computer skills preferred.

 

Experience:  

1. One year experience working in a data related environment.  
2. Knowledge and experience in Microsoft environment (Word, Excel, Outlook)
3. Prefer experience and training in billing or accounting related services.
4. Lived experience with behavioral health issues preferred.

 

Other Requirements:  

The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.

 

FLSA Status:  Non-exempt

 

Worker’s Compensation Code:  8810

 

Occupational Employment Statistical Code:  55338

 

Physical Requirements: (This job requires the ability to perform the essential functions contained in this description. These include, but are not limited to, the following requirements and working conditions. Reasonable accommodations will be made for otherwise qualified applicants unable to fulfill one or more of these requirements):

 

1. Ability to utilize office and computer equipment.
2. Requires high level of visual concentration and attention to detail in regards to data and documents.
3. Ability to lift and carry office files and folders and small equipment and materials.

 

Working Conditions:

1. Works primarily in an office setting.