Billing Specialist I at Fora Health Inc

Portland, Oregon, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Jul, 26

Salary

23.6

Posted On

24 Apr, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Coding certification, Electronic health record systems, Billing clearinghouse, Accounts receivable, Insurance claim status, Diagnosis coding, Billing codes, Modifier usage, Microsoft Office, Excel, Verbal communication, Written communication, Organizational skills, Attention to detail, Confidentiality, Time management

Industry

Hospitals and Health Care

Description

Description POSITION SUMMARY As a member of the Finance team, the Billing Specialist will be accountable for the claim balance of specifically assigned accounts. Duties will include obtaining payor authorizations, ensuring proper claim and modifier coding, communicating with Fora clinical staff and insurance companies to identify and solve issues, resubmitting and adjudicating denied and rejected claims, and applying payments as needed within the electronic health record system and web-based clearinghouse. This role will report directly to the Contracts and Billing Supervisor. ESSENTIAL JOB FUNCTIONS Process timely and accurate authorizations for patient services. Ensure claims are processed timely and with correct data points. Support identification of issues and implementation of corrective actions/process changes. Manage the Accounts Receivable aging to ensure outstanding balances are rectified in timely manner. Identify basis for denied claims, develop and communicate internal and/or external corrective actions, and resubmit claims where appropriate. Apply payments to clients’ accounts in a timely manner adhering to the month end cutoffs. Develop client statements and upon clinician request communicate client balance in a timely manner. Complete billing audits as required Participate in ad-hoc projects related to billings, collections or denials. Participate in billing and/or intake related meetings as necessary and offer advice/perspective as it relates to billings and authorizations. SUPERVISORY FUNCTIONS This position has no supervisory responsibilities Requirements QUALIFICATIONS EDUCATION AND EXPERIENCE REQUIRED Coding certification Electronic Health Record systems Billing Clearinghouse knowledge Calling or inquiring electronically with insurance companies to assess claim status Diagnosis, billing codes and modifiers Account receivable aging KNOWLEDGE, SKILLS AND ABILITIES REQUIRED Advanced knowledge of coding, modifier usage and denial reason codes Proficient in Microsoft Office applications, especially Excel Proficient in web-based insurance portals and billing clearinghouses Proficient in electronic health systems High level of verbal and written communication skills Strong organizational skills and attention to detail Ability to maintain confidentiality of sensitive information and documents Proven ability to prioritize responsibilities to ensure that they are completed in a timely manner OTHER REQUIREMENTS DHS Background Check Approval Successful completion of Drug Test upon hire Documentation of Tuberculin test and/or evaluation with negative results or evidence of non-communicability WORKING CONDITIONS This position has the potential to work remotely after the initial 90 days and upon supervisor approval.

Responsibilities

The Billing Specialist manages claim balances, processes authorizations, and ensures accurate coding for patient services. They are responsible for resolving denied claims, managing accounts receivable, and applying payments within the electronic health record system.