Billing Specialist (Union)Agency Name: OtherAgency Contact: Tracey FinallPosition Type: Full TimeJob Type: PermanentCounty: SanilacSalary Range: $18.91-$23.82 per HourSend applications to: include your resume when applying.Download this job posting.Position: Billing Specialist (Union) Position code: 26-22 Position Location: Administration Building Current Work hours: 40 HRS/WK Compensation Range: $18.91/HR-$23.82/HR If Annualized: $39,342.10-$49,549.19 Position Dates: ASAP Supervisor: Administrative Supervisor-Finance/BillingRequirements: Associate's Degree or equivalent from two year college or technical school in a medical billing/claim adjudication field; or 5 years of experience or training in third party insurance billing/claims adjudication process.Testing Requirements: Critical Thinking All internal and external job applicants are required to use UltiPro to apply for this position. Please see the Sanilac County CMH website at and click on "Employment".SANILAC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY 227 E. Sanilac Avenue Sandusky MI JOB DESCRIPTIONJob Title: Billing Specialist Department: Finance Location: CMH Administrative Building Supervisor: Admin. Supervisor – Finance/Billing Shift: M–F, 40 hour week Classification: 6 (Six) Prepared Date: 10/31/2013 HR Reviewed: 12/01/2014, 12/01/2015, 01/09/2017, 12/01/2017, 12/01/2018, 12/2/2019, 10/15/2020, 10/06/2022, 2/5/2024, 6/28/2024, 6/12/2025 Revised Date: 03/14/2014, 02/17/2016, 03/11/2017, 05/08/2017, 04/15/2020, 01/28/2021, 01/13/2023, 12/28/2023, 2/5/2024, 10/31/2024, 3/11/2026 Prepared By: CIO, CFO, Admin. Supervisor – Finance/Billing Reviewed By Supervisor: 3/19/2020, 4/6/2022, 11/10/2022, 2/05/2024, 6/16/2025SUMMARY Under the direction of the Admin. Supervisor – Finance/Billing, and in conjunction with the other Billing and Finance staff, completes duties as assigned in the areas of billing and reimbursement.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:• Generate appropriate billing for all 3rd party payers, secondary payers and COFR payers for all services, voiding and correcting errors, address and reprocessing rejections, and verifying waterfall through appropriate guidelines of insurance payers. Ensure that Medicaid is payer of last resort. Correspond with staff as necessary on issues arising from payer's rules/regulations.• Enter/process all 3rd party insurance payments for services provided, no matter the form of the remittance; to appropriate individual accounts in the Agency's electronic medical record (OASIS). Reprocess/address all 3rd party payer rejections and rebill all 3rd party payers as appropriate and in a timely manner. Generate Open-Line-Item reports monthly for all 3rd party payers and address all services from prior billing months appropriately to ensure that all (open) services have been rebilled appropriately within a timely period. Keep reconciled monthly Open-Line-Item reports on file for all 3rd party payers.• Process all provider claims through the computer system's claim adjudication process within the appropriate guidelines of the Agency and PIHP.
Send claim rejections to appropriate staff/providers and follow-up as needed. Submit invoices to the Finance staff as appropriate. Complete Financial Determinations at intake and annually for all non-Medicaid individuals. Track/monitor ability to pay information/appointments on the shared calendar. Keep current and up to date on MDHHS ability-to-pay rules.• Complete periodic Claims Verification Reviews as assigned.• Assist with COFR eligibility and authorization requests as needed• Complete monthly, quarterly, and annual reports for the CFO and/or Admin. Supervisor – Finance/Billing.• Process and submit all encounters timely based on the current PIHP schedule.• Keep current and up to date on MDHHS ability-to-pay rules. Generate monthly ability-to-pay statements to individuals served. Complete ability-to-pay appeals as received in a timely manner.• Process and submit all funding request paperwork, adjusting funding sources as necessary.• Read, distribute and update staff on Medicaid, Medicare, BCBS, and MI Child Bulletins.• Attend MARO and other billing trainings as appropriate.• Assists in audit preparation.• Stay current with and follows Agency policies and procedures.• Stay current with and follows Agency trainings and procedures.• Perform other duties as assigned.COMPETENCIES FOR ADMINISTRATIVE STAFF Sanilac CMH staff are dedicated to providing services to the community to improve lives. When they see a task that needs to be completed, they step in to assist or are first in line to help the Agency in promoting recovery, discovery, and independence. Each staff member works within their strengths and collaborates with their coworkers so that collectively we are a stronger whole. Staff provide positive feedback and suggestions to improve the quality of care in the Agency.
They hold their coworkers, the individuals they serve and the community in high esteem.To perform the job successfully, an individual should demonstrate the following competencies:Initiative/Organization/Reasoning: Takes initiative and steps in to take on difficult challenges. Willing to identify problems and work to resolve them in the early stages. Plans and organizes work activities and uses time efficiently. Properly organizes and carries out job tasks in a timely manner. Is a self-starter in attaining job objectives. Know and understands job expectations and is willing to expand job knowledge and skills to be more effective to the Agency and the individuals served. Is enthusiastic about the Agency's Mission and is a positive influence for co-workers and individuals served. Demonstrates an understanding of and adherence to Agency policies and procedures and is willing to provide suggestions to make policies and procedures more efficient. Is willing to think outside of the box while able to make sound decisions and taking actions based on sound reasoning and weighing possible outcomes.Ethics/Teamwork: Consistently treats all people with dignity and respect. Demonstrates expected ethics and principles. Accepts responsibility for actions and follows through on commitments.
Demonstrates ability and willingness to work cooperatively and effectively as part of a team. Willingly acknowledges team members and co-workers' value to your work.Emotional Intelligence: Verbal and written communication is constructive, effective, respectful, and clear. Demonstrates the ability to adapt to changes in work situations. Willing to take the time to learn about co-workers' personality so that working together is more effective. Willingness to ask questions, listen to others' ideas, and understand how the impact of your work, impacts your co-workers/team. Establishes and maintains effective relationships. Willing/Ability to be cost conscious Staff are expected to learn and understand job functions and carryout tasks in a proficient manner.SUPERVISORY RESPONSIBILITY This job has no supervisory responsibilities.QUALIFICATION REQUIREMENTS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to