Philadelphia FIGHT is seeking a detailed-oriented and experienced Billing Specialist to join our team. This role plays a key part in supporting the organization's revenue cycle and ensuring timely reimbursements. The ideal candidate will be responsible for managing claims processing, payment posting, insurance verification, denial follow-up and maintaining accurate patient billing records.

About the Role:

• Schedule: Full time, Monday through Friday (9:00 – 5:00PM)
• Location: Philadelphia FIGHT, 1233 Locust Street, 3rd Floor, Philadelphia, PA 19107
• Compensation & Benefits:
• FSLA status is non-exempt with an hourly rate of $20.25 per hour.
• 3 weeks of PTO (4 weeks after 1st year) + 11 paid holidays.
• Comprehensive Medical, Dental, Vision & Prescription Coverage.
• Employer-funded Short-Term Disability coverage and Life & Accidental Death and Dismemberment (AD&D).
• Flexible Spending Accounts (FSA) and Health Reimbursement Arrangements (HRA) with employer contribution.
• 403(b) Retirement Savings Plan with options for basic plan or Roth 403(b) contributions with employer matching up to 4%.
• Discounted education options with partnered institution Pierce College.
• And a multitude of other employee perks, including but not limited to, the option to contribute to medical discount programs, legal services, charitable contributions, and pet insurance coverage!

Qualifications:

1. A high school diploma required. Associate's/Bachelor's degree in related field is preferred.
2. 2+ years of related experience in medical/electronic billing required.
3. Certificate in medical billing and coding is preferred.
4. Must possess basic computer skills to perform job duties including desktop computing, e-mail, time sheet management, HRIS, internet research, etc. and the ability to learn software applications relevant to your position. Computer proficiency and technical aptitude with the ability to utilize and produce reports on Microsoft Word, Excel, etc.
5. Must possess knowledge of Pennsylvania Medicaid, Medicare and third-party billing practices.
6. Strong skillsets in oral and written communication, cultural competence, interpersonal relationships and teamwork, attention to detail, customer service, time management, autonomy, problem solving and organization.
7. Demonstrated analytical ability, abstract reasoning skills, and excellent organization skills.
8. Must be able to work under pressure and meet deadlines while maintaining a positive attitude and providing exemplary customer service.
9. Effective project and process management skills as demonstrated from past work experience.
10. Ability to maintain confidentiality with compensation data and sensitive financial matters.
11. Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.
12. Must be able to exercise good judgment and identify when to escalate issues as appropriate.
13. Ability to remain solution-focused and respectful in all interactions with staff, co-workers, vendors, and patients.
14. Excellent problem-solving and conflict resolution skills.
15. Ability to display a non-judgmental attitude.

Responsibilities include:

1. Ensures accuracy and completeness of patient encounter forms to submit claims; takes necessary actions to correct encounter forms as needed by contacting the provider and/or appropriate party.
2. Collaborates with providers or other appropriate parties to receive all information needed to complete the billing process.
3. Ensures FIGHT's billing procedures are conducted to ensure accuracy and timely billing; conducts quality assurance measures as appropriate.
4. Conducts all billing activities for managed care, commercial insurance Medicare and Medicaid, including verifying insurance, processing patient claims for services rendered, processing data batches, transmitting/submitting documents to insurance companies, etc.
5. Posts health service charges and payments from health center patients, Medicaid, Medical and other health insurance carriers daily.
6. Resolves patient inquiries and issues including those resulting from incorrect or incomplete information.
7. Builds and maintains relationships with insurance companies as needed; contacts them as needed to resolve insurance issues and/or expedite claims processing.
8. Documents all activities related to billing (detailed actions taken to resolve outstanding claim and account issues, charge information, etc.) appropriately in the Electronic Medical Record within the established timeframe set forth by FIGHT policy.
9. Maintains patient demographic information and data collection systems, including all billing/collection reports while remaining in accordance with payer and company policy guidelines.
10. Recognizes, interprets and evaluates inconsistencies, discrepancies and inaccuracies in accounts receivable and system files and initiates appropriate corrective methods; works to increase error resolution/denial management.
11. Reviews claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission.
12. Remains knowledgeable of new coding rules as codes change for purposes of accurate billing.
13. Reviews, evaluates and re-files appeals for denied and unpaid claims as appropriate.
14. Reviews coding information about diagnosis on charge and procedures performed to produce claims to insurance companies, ensuring that codes tally with provider's diagnosis.
15. Prepares billing adjustment and/or rebilling and filing appeals as necessary.
16. Processes and distributes billing rejection notices in compliance with clinic policies.
17. Prepares, composes, updates, monitors and edits internal and external billing/accounts receivable reports, records and files.
18. Maintains compliance with all FIGHT policies and procedures. Reports known conduct taken by any FIGHT employee (including yourself) which violates any FIGHT policy or law on which you have been trained, or should know of, such as laws criminalizing theft or violent crimes, and reports the matter to management.
19. Other duties as assigned to fulfill FIGHT's mission.

FIGHT is an EEO, Affirmative Action, LGBTQ, people living with HIV/AIDS, and protected veterans' institution. We are dedicated to recruiting, hiring, and retaining employees from many backgrounds.

We recognize that an inclusive workforce with a variety of views, perspectives, and backgrounds is an integral part in our organizational success. We encourage and embrace a diverse workforce that provides us with unlimited ideas and innovative solutions.