JOB SUMMARY

Provides billing and collections on behalf of the patient for all of the following: Medicare, Medicaid, Commercial insurance, any government agencies, and all third-party liability claims. Responsible for tracking multiple insurances to resolve any unpaid balances. Assists patients/families with financial arrangements, including financial assistance, for qualified patients from outside agencies.

PRIMARY FUNCTIONS

• Maintain and audit accounts receivables/credits over 45 days old monthly, documenting notes for productivity.
• Work on 30 accounts per day or an average of 150 per week.
• Communicate effectively with billing staff for improvements in billing primary and secondary claims.
• Review insurance EOBs for potential processing errors.
• Respond to denials and requests/correspondence within a two-day timeframe.
• Ensure accurate designation of balances between insurance and patients.
• Assist patients with inquiries over the phone or in person.
• Respond to audits and regulatory inquiries.
• Research credit balances for assigned insurances.
• Educate other staff on assigned payers.
• Serve as the representative for specific payers for the organization.
• Answer patient questions regarding statements or billing inquiries.
• Effective communications with other departments for timely corrections
• Other duties as assigned

EDUCATION AND EXPERIENCE

• High school degree or GED;
• One to three years data entry and billing and claims experience in healthcare setting or billing externship. Education or knowledge may be substituted for the experience requirement
• Experience in a multispecialty clinic setting.

PREFERRED LICENSE/CERIFICATIONS

• Billing Certificate, the result of graduation from a certified billing school;
• Coder and/or Billing Certificate may be substituted with demonstrated proficient knowledge of healthcare billing processes.

KNOWLEDGE, SKILLS, AND ABILITIES

• General knowledge of computerized practice management systems, preferably Cerner Electronic Health Record System.
• Ability to learn billing and collection system within rural health facilities and critical access hospitals.
• Ability to communicate with tact and diplomacy with diverse groups of people including staff, providers, and insurance companies on behalf of the organization.
• Ability to display sensitivity to the patient population being served
• Ability to work on a variety of assignments concurrently within established deadlines
• Ability to work with others in a problem solving and team environment and to work alongside staff as needed
• Knowledge of HIPAA as it relates to medical & behavioral health billing
• Position requires a high level of accuracy and attention to detail
• Ability to communicate effectively, both orally and in writing
• Ability to respond effectively to sensitive inquiries or complaints
• Ability to work independently with minimal supervision
• Proficient with computers and MS Windows software programs
• Knowledge of Federally Qualified Health Care billing and reimbursement preferred
• Knowledge of Medicare and Medicaid guidelines
• General knowledge of UB04, HCFA1500 Electronic and Paper claim forms

ADDITIONAL QUALIFICATIONS

1. Bilingual a plus (English / Spanish) preferred
2. Healthcare experience highly preferred

RELATIONSHIP REPORTING

1. Reports to the PFS Director

PHYSICAL REQUIREMENTS

1. Ability to sit, stand and or walk for extended periods of time
2. Ability to view a computer screen for extended periods of time
3. Ability to perform repetitive hand and wrist motions for extended periods of time

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