Thecentersohio
Nancy lyon porter building, 4500 Euclid Ave, Cleveland, OH 44103, USA
Job Description
Posted Thursday, July 24, 2025 at 4:00 AM Job Summary
The Advance Billing and Insurance Specialist performs tasks essential for revenue collection and account management associated with accounts receivable. The ideal candidate will have:
High school diploma or GED, with advanced training in billing and insurance verification. Three to five years of experience in billing for Medicare, Medicaid, and commercial insurance, including credentialing. Proficiency in handling pre-accounts receivable work lists and managing claims denied by payers. General knowledge of CPT/HCPCS and ICD-10 coding guidelines. Thorough understanding of registration and insurance verification processes within the OCHIN EPIC EHE system. Preferred experience in accounting and accounts receivable management. Collaborates with an external billing vendor and internal billing staff to ensure continuous billing to Medicare, Medicaid, the Ohio Department of Job and Family Services, and commercial payers. Acts as a liaison between the third-party billing company, Human Resources, and healthcare providers regarding the rostering and credentialing of Medicare, insurance, and Medicaid-eligible staff. Provides ongoing education on registration and insurance verification to Benefits and Front Office staff. Demonstrates proficiency in navigating the PNM system. Works Pre AR and follow-up work queues/work lists Reviews Remittance Advice and Explanation of Benefits (EOBs) for accuracy. Verifies the proper posting of payments by the third-party billing company and reconciles this with cash payments received by the organization. Supplies the third-party billing company with the necessary registration and clinical information required to address denied claims and facilitate collection activities. Monitors service authorizations and pre-certifications, collaborating with enrollment staff to ensure that proper approvals have been requested. Keeps track of state remittance reports and adheres to funding regulations. Ensures the confidentiality of client and organization information. Collaborates with the immediate supervisor to propose adjustments to current work lists and processes aiming to optimize billing efficiency. Assists in reviewing and updating all billing forms and documented processes as needed. Can provide backup support by reviewing daily cash sheets and general ledger entries in Solomon to ensure they balance with entries in Electronic Health Records. Assists with bank deposit transactions and processing as necessary. Performs follow-ups on outstanding invoices or discrepancies as requested. Other Job Duties & Responsibilities Attends training seminars and monitors the websites of various funding sources to stay updated on current information, offering suggestions for implementation. Other duties as assigned. This position does not supervise any staff. Physical Demands/Work Environment This job operates in a professional office environment, which usually has a moderate noise level due to conversations, office machinery, and communication devices. The atmosphere is generally collaborative, although it can vary based on the team's dynamics. The position may involve prolonged periods of sitting at a desk or standing, along with frequent computer use. This requires proficiency in handling office equipment, such as printers, copiers, and telephones. Occasionally, the job may involve lifting light to moderately weighted items, such as office supplies or files. Additionally, travel and work outside of normal hours may be necessary for meetings, presentations, training sessions, and other events. This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of The Centers. The Centers
is an
Equal Opportunity Employer
and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status, or any other characteristic protected by law. Nancy lyon porter building, 4500 Euclid Ave, Cleveland, OH 44103, USA #J-18808-Ljbffr
Posted Thursday, July 24, 2025 at 4:00 AM Job Summary
The Advance Billing and Insurance Specialist performs tasks essential for revenue collection and account management associated with accounts receivable. The ideal candidate will have:
High school diploma or GED, with advanced training in billing and insurance verification. Three to five years of experience in billing for Medicare, Medicaid, and commercial insurance, including credentialing. Proficiency in handling pre-accounts receivable work lists and managing claims denied by payers. General knowledge of CPT/HCPCS and ICD-10 coding guidelines. Thorough understanding of registration and insurance verification processes within the OCHIN EPIC EHE system. Preferred experience in accounting and accounts receivable management. Collaborates with an external billing vendor and internal billing staff to ensure continuous billing to Medicare, Medicaid, the Ohio Department of Job and Family Services, and commercial payers. Acts as a liaison between the third-party billing company, Human Resources, and healthcare providers regarding the rostering and credentialing of Medicare, insurance, and Medicaid-eligible staff. Provides ongoing education on registration and insurance verification to Benefits and Front Office staff. Demonstrates proficiency in navigating the PNM system. Works Pre AR and follow-up work queues/work lists Reviews Remittance Advice and Explanation of Benefits (EOBs) for accuracy. Verifies the proper posting of payments by the third-party billing company and reconciles this with cash payments received by the organization. Supplies the third-party billing company with the necessary registration and clinical information required to address denied claims and facilitate collection activities. Monitors service authorizations and pre-certifications, collaborating with enrollment staff to ensure that proper approvals have been requested. Keeps track of state remittance reports and adheres to funding regulations. Ensures the confidentiality of client and organization information. Collaborates with the immediate supervisor to propose adjustments to current work lists and processes aiming to optimize billing efficiency. Assists in reviewing and updating all billing forms and documented processes as needed. Can provide backup support by reviewing daily cash sheets and general ledger entries in Solomon to ensure they balance with entries in Electronic Health Records. Assists with bank deposit transactions and processing as necessary. Performs follow-ups on outstanding invoices or discrepancies as requested. Other Job Duties & Responsibilities Attends training seminars and monitors the websites of various funding sources to stay updated on current information, offering suggestions for implementation. Other duties as assigned. This position does not supervise any staff. Physical Demands/Work Environment This job operates in a professional office environment, which usually has a moderate noise level due to conversations, office machinery, and communication devices. The atmosphere is generally collaborative, although it can vary based on the team's dynamics. The position may involve prolonged periods of sitting at a desk or standing, along with frequent computer use. This requires proficiency in handling office equipment, such as printers, copiers, and telephones. Occasionally, the job may involve lifting light to moderately weighted items, such as office supplies or files. Additionally, travel and work outside of normal hours may be necessary for meetings, presentations, training sessions, and other events. This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of The Centers. The Centers
is an
Equal Opportunity Employer
and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status, or any other characteristic protected by law. Nancy lyon porter building, 4500 Euclid Ave, Cleveland, OH 44103, USA #J-18808-Ljbffr