Central Billing Representative I

Job Title: Central Billing Representative I

Position Code: A15N Non-Exempt

Department: Central Billing

Position Category (330): Fiscal and Billing Staff (L30b)

Position Category (Rphca): Administration Staff

Union Exempt: Yes

The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. 

POSITION SUMMARY

Under the direct supervision of the Director of Revenue Cycle Management, the Central Billing Representative I is responsible for maintaining a high-performance work environment characterized by positive relationships and a strong orientation towards customer service and timely quality patient billing. The Central Billing Representative I is responsible for direct interaction and assistance to Site Biller Representatives, patients, physicians, colleagues, contractors and consultants for the purpose of billing, collection and reporting of multi-specialty self-pay, third party payer accounts receivable and claims on a daily basis. 

ESSENTAIL DUTIES AND RESPONSIBILITIES

• Review of site batched patient encounters for charge and payment accuracy, as needed including encounter rate and or other necessary billing adjustments;
• Monitor and review site unbilled encounters and assist when necessary to meet mutual daily and weekly deadlines;
• Provide education on encounter batches as appropriate to minimize error reoccurrence and support maximum reimbursement;
• Meet all EOM (end of month) closing activities and deadlines;
• Coordinate electronic patient statements on a monthly basis;
• Post payments received and reconcile system postings to lockbox &/or EOB (explanation of benefits) totals;
• Record NSF checks returned by bank and notify patient of adjusted balance due;
• Review credit balance reports and prepare refund requests for overpayments;
• Participate in billing Helpdesk customer support, by receiving, responding and documenting all incoming account inquiries including electronic, telephone and written correspondence related to billing issues;
• Review assigned outstanding A/R to identify problems with various insurance payers (-i.e. Medicare, Medicaid, Commercial, Contracts and Self-Pay). Perform all routine and special 
• follow-up on all assigned payer type accounts to affect collection of patient and insurance account balances;
• Review and resolve all EOB’s including those without payment to initiate clean claim resubmission and claim reimbursement;
• Demonstrate ability to edit & submit insurance claims for fee for service and prospective payment system reimbursement;
• Resolve unapplied cash, errors in cash reconciliation and changes in payment allocation to insurance payer types;
• Communicate payment terms and establish agreed-upon payment plans for overdue patient and insurance account balances. Monitor payment compliance with terms of established plans with patients and insurance plan provider representatives;
• Evaluate uncollectible patient and insurance accounts and make recommendations concerning account write-offs and/or placement as bad debt status;
• Complete bad debt process based on FCCH procedure;
• Document activities on accounts, including corrections and collection activities in the practice management system and additional MS Word software tools provided;
• Initiate & complete account adjustments to correct account balance and/or comply with contractual and sliding fee scale requirements;
•  Assist and train other staff members as requested in the areas of registration and billing;
• Assist Site Biller Representatives and cover and perform their functions in their absence.
• Responsible for all other duties as assigned;

MINIMUM EDUCATION AND EXPERIENCE

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

PREFERRED LICENSE/CERIFICATIONS

• Certified Coder (medical and/or dental);
• Billing Certificate, the result of graduation from a certified billing school;
• Coder and/or Billing Certificate may be substituted with demonstrated proficient knowledge of procedural CPT & Dental Coding and/or ICD-10 diagnosis coding;

KNOWLEDGE, SKILLS, AND ABILITIES

• General knowledge of computerized practice management systems, preferably Cerner PWPM Practice Management System, Cerner Electronic Health Record System and Dentrix Dental billing and E H R;
• Ability to learn billing and collection system within federally chartered community health centers (CHC) and RHI/UHI programs;
• 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, dental & 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;
• Working knowledge of CPT, Dental ADA, DSM V and ICD-10 preferred;
• Knowledge of Medicare and Medicaid guidelines;
• General knowledge of UB04, HCFA1500 and Dental ADA Electronic and Paper claim forms;
• Knowledge and familiarity with compliance program. Cooperate fully and comply with laws and regulations;

AGE OF PATIENT SERVED

      N/A

PHYSICAL CHARACTERISTICS/WORKING CONDITIONS

A person in this position has to be able to prioritize and respond to the diverse demands of the position. There are frequent opportunities to relax from any physical exertion, change position in work activities, or break from computer application tasks.

• Physical Effort and Dexterity: Good dexterity to operate personal computer and office equipment. Occasional lifting and carrying related to office duties. 
• Machines, Tools, Equipment required to be operated: Capable of using office machines and personal computers for word processing, data entry and spreadsheet applications.   
• Visual Acuity, Hearing, and Speaking: Must be able to read a computer monitor and outputs accurately. Must be able to clearly and accurately communicate for work, safety and compliance.
• Environment/Working Conditions: Work is mostly inside an office in a controlled environment. Normal office safety precautions and practices are required. Position requires travel throughout the Albuquerque metropolitan area. Work regularly scheduled Monday-Friday, although weekends and evenings may be required to meet with members of the Board of Directors and meet deadlines.