Company Intro: Ocean Health Initiatives, Inc. (OHI) is a Federally Qualified Health Center (FQHC) dedicated to providing quality, accessible and comprehensive primary health care to the residents of Ocean and Monmouth County; regardless of economic status.

Our Health Center Locations: Brick, Freehold, Lakewood, Little Egg Harbor, Manahawkin, Manchester and Toms River; with our school-based Wellness Programs located within the Clifton Ave Grade School, Lakewood; and Lakewood High School.

OHI services include family and internal medicine, pediatrics, behavioral health, nutrition, OB/GYN women’s health, dental, family planning, specialty care, pharmacies, PrEP, and a STI clinic.

Position Summary

Reporting to the Billing Manager, the Billing Specialist is responsible for the daily review and proper coding of patient encounters to ensure the billing of clean claims, data retrieval and analysis. Identifies payer trends and resolves claim denials. Assists in various other billing or financial processes as needed and as assigned.

Responsibilities

• Follow-up of delinquent account balance utilizing aging reports.
• Assists patients with account balance questions or concerns; answers all billing, patient, and insurance inquiries.
• Creates claims for electronic submission daily while ensuring coding is correct for payer. Prints and mails claims as needed.
• Manually processes insurance and/or patient payments.
• Posts contractual adjustments.
• Serves as a backup for presumptive eligibility (PE).
• Frequent contact with insurance companies relating to member eligibility, claim status and other relevant topics.
• Tracks payer denials. As needed reviews, corrects and resubmits claims for payer reimbursement reconsideration.
• Identifies payer trends and policy changes for quick resolution.
• Answers all calls to the Billing Department and provides assistance whenever needed.
• Completes assigned tasks in a timely manner.
• Understands the departments Key performance metrics. Strives to meet and maintain goal metrics.
• Maintains a monthly passing scorecard 80%.
• Queries providers when code assignments are conflicting or unclear for accurate billing.
• Manual input of charges as needed.
• Maintains proficiency in Billing platform and EMR.
• Assists in other financial or billing related issues.
• Is highly accountable for one's own productivity. In order to maintain transparency, all projects must be represented clearly on a project board in Monday.com. Responsible for ensuring the board is always updated and accurate and that information is accessible to those that need it.
• Completes all mandatory in-services and attends all required meetings.
• Adheres to Corporate Compliance policies.
• Other duties as assigned.

Education/Experience/Licensure

• High School diploma or equivalent required.
• Bi-lingual (English/Spanish) is preferred.
• One to two years of experience in the billing department in medical centers, private physicians’ office, or other applicable health care setting.
• Medical Billing Certification is preferred or relevant years of experience.
• Proficiency in Microsoft Office 365 is required.

Benefits:

• Paid Time Off (PTO)
• Holidays (8)
• Health Insurance
• Dental Benefits
• 401(k) + 5% match
• Group Term Life Insurance
• Flexible Spending Account

Pre-Employment Requirements:

• Physical
• Criminal Background Checks
• Drug Screening
• Tuberculosis Screening

Ocean Health Initiatives is firmly committed to creating a diverse workplace and is proud to provide equal employment opportunities to all applicants. Therefore, Ocean Health does not discriminate on the basis of creed, color, national origin, sex, gender identity, sexual orientation, age, religion, marital or parental status, alienage, disability, political affiliation or belief, military or military discharge status.

In accordance with New Jersey Executive order (COVID-19 No.283) in conjunction with the Federal CDC guidelines, COVID vaccinations are a requirement for Ocean Health Initiatives as well as many other Healthcare Organizations. Proof of full vaccination and the booster shot is required prior to the beginning date of employment. If you have a medical or religious contraindication, please inform Human Resources when the offer is extended.