Job Title: Billing Specialist

Status / Time: Full-Time
Reports to: Revenue Cycle Specialist
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:

  • Transmit and retrieve EDI responses and process daily

  • Retrieve/process charges daily (billables & reportables)

  • Approve claims entered, fix approved failed and re-approve daily

  • Batch claims and/or file paper claims daily

  • Work filed rejected and EDI response rejections daily

  • Transmit batches a second time daily

  • Query all new/in progress claims daily

  • Follow up on Filed over 30 days

• Follow up paper rejections and correspondence weekly.

• Enter payments daily on day received. Balance cash reports daily and monthly.

• Update patient insurance information in a timely manner as the information becomes

  apparent.

• Hard close practice management system monthly within 5 working days of month

  end. Advise accounting once closed.

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

  practice management system.

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

• Request refunds to patients when there are overpayments.

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

  Planning & any others). Review to ensure coding is accurate and appropriate to

  program. Coordinate necessary follow up with Clinical and Eligibility staff as needed

  and give final report to Accounting.

• 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.

• Prepare, review, and submit accurate claims to insurance companies or clients.

• Follow up on outstanding payments and rejections in a timely manner.

• Post payments and reconcile accounts.

• 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).

Ability to Commute:

• Hau‘ula, HI 96717 (Required).

Work Location:

• Onsite at Hau‘ula, HI 96717 with potential for hybrid after probationary period, with

  minimum three days onsite.

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.