Job Description

ESSENTIAL FUNCTIONS of this job description include but are not limited to:

• Prepares and submits clean claims to third party payers either electronically or by paper.
• Maintains relationship with clearinghouse, including appropriate follow-up with support issues.
• Coordinate the process of patient eligibility through various third party sources.
• Coordinate collection process, to include any projects from accounts and tracking current collections in Evident.
• Manage monthly statement process, to include reviewing statements before mailing and field any patient inquiries the Patient Services staff needs to escalate.
• Coordinate and administer policy and procedure for sliding scale.
• Work with reception staff, ensure appropriate collection of co-pay, spend down and self-pay fees.
• Handles patient inquiries and answers questions from clerical staff and insurance companies.
• Identifies and resolves patient billing problems.
• Denial and insurance follow-up management.
• Issues adjusted, corrected, and/or rebilled claims to third party payers.
• Posts adjustments, transfer of responsibility and refunds, as necessary.
• Assure coding is compliant and up to date.
• Reviews accounts and makes recommendations to the Controller regarding non collectible accounts.

• Maintains safe, secure, and healthy work environment by following, and enforcing standards and procedures; complying with legal regulations.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Performs other tasks and duties as assigned in an efficient, effective and cost conscious manner, complying with all hospital policies, procedures, and regulations.

KNOWLEDGE, SKILLS, QUALIFICATION and EDUCATIONAL AND /OR EXPERIENCE REQUIREMENTS:

• Previous medical billing experience including knowledge of billing related reporting; 3 - 5 years’ experience in health-care billing & collection practices, preferably with an FQHC
• Experience working with medical payers including Medicare, Medicaid, and commercial insurance
• Working knowledge of medical billing systems
• Experience with Medicaid’s State Eligibility System
• Working knowledge of CPT and ICD-9 & ICD-10 coding systems; Coding certification preferred
• An Associate Degree from an accredited university with credentials in billing / coding preferred
• Excellent organizational skills, and
• Proficiency in Microsoft Office Suite
• Strong organizational and interpersonal skills
• Ability to:
  • determine appropriate course of action in more complex situations
  • work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
  • manage multiple and simultaneous responsibilities and to prioritize scheduling of work
  • maintain confidentiality of all medical, financial, and legal information
  • complete work assignments accurately and in a timely manner
  • communicate effectively, both orally and in writing/electronically
  • handle difficult situations involving patients, physicians, or others in a professional manner
• Provide excellent customer service skills and basic computer skills required
• Possesses good interpersonal skills, initiative, integrity, flexibility, adaptability, and must be a team player

PHYSICAL DEMANDS / WORKING CONDITIONS:
Sitting, standing, walking bending/twisting, kneeling/squatting, reaching, climbing and should be able to lift 25 or more pounds using proper lifting techniques.  Rapidly changing and stressful environment.  Ability to communicate with various levels of people.  Possible exposure to communicable and infectious disease and hazardous materials. Occasional exposure to unpleasant patient or unit elements (accidents, injuries and illness).  Contact with patients under a wide variety of circumstances.  Subject to varying and unpredictable situations.  Handles emergency or crisis situations.  Subject to many interruptions.  Occasional pressure due to multiple tasks and inquiries. 

The information in this job description is intended to describe the general nature and level of work being performed by people assigned to this classification and requirements for the performance of this job. 

They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

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