Job Title: Billing Specialist

Status / Time: Full-Time
Reports to: Revenue Cycle Manager
Position Type: Permanent
FLSA Classification: Non-Exempt
Hourly Range: $20.00 to $28.00

Job Description & Overview
To implement the revenue cycle using the Billing Status Workflow process to ensure timely
submission of claims, mailing of statements and subsequent payment. The Billing Specialist
works closely with the front office and providers on staff to ensure accurate and timely
information.

Duties:

Execute the Billing Status Workflow process as follows:

• Work closely with third party to ensure accurate and prompt billing

• Follow up on filed claims over 30 days

• Follow up on rejections and correspondence weekly

• Review Time of Service payments and reports daily, weekly, monthly

• Post/reconcile bank deposits in the system

• Work with front office to update patient insurance information as needed in a timely

  manner when it becomes available

• Document in the claim notes all billing/collection actions taken on an individual account

  in the current practice management system

• Secondary insurance review and follow-up including sliding fee discount program

• Counsel patients in setting up payment plans to recover outstanding balances and report

  them to the CEO or COO for final approval

• Request refunds to patients when there are overpayments

• Generate monthly reports for uninsured contracts (DOH Primary Care, Family Planning

  & any others)

• Provide feedback to clinic operations staff and medical providers to ensure appropriate

  coding of encounters

• Adhere to State collections and credit regulations

• Adhere to applicable Federal and State laws and regulations

• Maintain detailed billing records and support audits

• Stay updated on payer rules, billing codes, and compliance regulations

• Respond promptly to billing inquiries from internal and external stakeholders

• Download Explanation of Benefits/Remittance Advice from current practice management

  system and insurance websites for KHC records and audit purposes

• Maintain a list of the Explanation of Benefits/Remittance Advice and reconcile to bank

  statement

• Work with third party credentialing vendors to get new Facilities/Providers credentialed

  or current Facilities/Providers re-credentialed. This may include calling insurance for

  requirements, completing application forms and submitting requested documents.

  Follow-up status calls when insurances are taking longer than usual.

• Review insurance refund request including contacting insurance for clarification.

  Complete internal refund request form and attach supporting documents. Post refund in

  the system and mail to the insurance.

• Other duties as assigned

Qualifications:

• High school diploma or equivalent (associate’s degree preferred).

• Minimum of 2 years' experience in billing.

• Proficiency in billing software and electronic claims submission.

• Strong analytical and communication skills.

• High attention to detail and organizational ability.

• Willingness to learn additional roles to support department continuity.

Preferred Skills:

• Current knowledge of ICD-CPT coding.

• Proficient in Microsoft Office (Word, Excel).

• Strong verbal and written communication skills.

• Good attention to details and follow up, good time management.

• Ability to work alone and with initiative.

• Ability to work effectively with different types of people.

• Maintains a positive and helpful attitude; remains calm during times of stress and

  urgency.

• Ability to maintain confidentiality and patient privacy.

Experience:

• Medical billing: 2 years (preferred).

Schedule:

• Monday to Friday – (hours within 7 am to 5 pm) (1-hour unpaid lunch required)

Ability to Commute:

• Hau‘ula, HI 96717 (Required).

• Between Kahuku and Hale Aha sites as needed

• External meetings as needed

Work Location:

• Onsite at Hau‘ula, HI 96717

Benefits:

• 401(k)

• 401(k) matching

• Health Insurance

• Dental insurance

• Vision insurance

• Life insurance

• Flexible spending account

• Paid time off

Clearance:
Proof of immunization or serology required for:

• TB Screening

• Hepatitus B

• Influenza

• Measles, mumps, and Rubella (MMR)

• Varicella

• Tetanus, Diphtheria, and Pertussis

ADA Statement: The Americans with Disabilities Act prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation. It also mandates the establishment of TDD/telephone relay services.

EEO Statement: Ko‘olauloa Health Center believes that all applicants and employees are entitled to equal employment opportunities and maintains a policy of non-discrimination with respect to religion, color, sex, sexual orientation, national origin, age, veteran status, marital status, physical or mental disability, or any other legally protected class in accordance with applicable law, except where a bona fide occupational qualification exists.

Ko‘olauloa Health Center will comply with all phases of employment including, but not limited to, hiring practices, transfers, promotions, benefits, discipline, and discharge.

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by employees assigned to this position. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as qualified.

Ko‘olauloa Health Center is a drug-free and alcohol-free workplace.