Medical Billing Specialist - FQHC

Job Purpose:

Maintenance of account which includes AR follow up, payment posting & balancing, filing claims & managing rejections, as well as generating statements and receiving inbound patient calls. 

Responsibilities:

·       Contact insurance companies regarding claims.

·       Process and follow up on appeals to insurance companies.

·       Answer patient inquiries.

·       Filing of all claims.

·       Post and balance payments, if applicable

·       Maintain productivity standards and goals set by the department and/or manager.

·       Maintain standard quality measures and goals.

·       Proactively resolve any cash restraining issues by seeking out and identifying trends in each facility’s AR

·       Follows up on non-responded and denied insurance claims for all third-party carriers (Self-Pay, Private, HMO/PPO and Gov’t payers).

·       Processes insurance/patient correspondence with insurance carriers to resolve adjudication issues.

·       Resolve any issues affecting reimbursement and/or adjudication in a timely manner

·       Available to patients and clinical departments to address specific payer issue

·       Provide feedback to Revenue Cycle Management based on the monthly review of AR

·       Maintain strict confidentiality within medical practice and HIPAA compliance.

·       Attend Meetings as required and/or participate in various committees as required

·       Other duties as assigned by, Manager, Director, VP RCM.

Required Skills:

• High school diploma/GED

·       Preferably two years’ prior experience in physician professional billing (Managed Care, Commercial and or CMS Part B claims adjudication, including but not limited to:

§  Explanation of Benefit forms (EOB)

§  Credit balances (discounts and refunds)

§  Insurance carrier billing requirements

§  Collections

§  Familiarity of payer provider enrollment

Core Competencies: 

Accountability and Self-Management

·       Must be detail-oriented and organized

·       A self – starter capable of tracking to deadlines and meeting goals with little supervision required

·       A high level of analytical and problem solving skills is expected

Teamwork and Leadership

·       Ability to work autonomously and as a team player, and display some leadership qualities

Communication

·       Excellent communication, customer service, and organizational skills

·       Strong verbal and written communications is desirable;

Innovation and Problem Solving

·       Attention to detail and moderate analytical and problem solving skills is expected

Computer Skills                                                         

·       Must possess general office skills and computer knowledge

·       Strong working knowledge of the Aprima EPM practice management system and/or GE Centricity Business system and coordinating modules, is preferred

·       MS Excel Spreadsheet software, MS Word Processing software and MS Power Point software.

             Physical Demands:

·       May require sitting for long periods of time; also, stooping, bending, and reaching for files and supplies.

·       Requires manual dexterity sufficient to operate a computer keyboard, answer a telephone, and run a copier and other office equipment as necessary.

·       Employee must participate to help maintain the desirable work environment created by the management and company officials.