ESSENTIAL JOB RESPONSIBILITIES

Billing and Denials Management

Reviews Compliance of Sliding Fee Discounts and Adjustments

Processes and Reviews Patient Statements monthly.

Collects Self-Pay delinquent accounts by establishing payment arrangements with patients; monitoring payments; following up with patients when payment lapses occur.

Reconciles third party physician reimbursements with monthly Ryan White invoice.

Reconciles third party medical HCFA approvals with outstanding HCFA’s to be paid.

Responds to all third party physician related issues regarding reimbursements, unbillable codes, incomplete/insufficient documentation, and patients.

Validates denial reasons and ensures coding is accurate and reflects the denial reasons.

Generates appeal based on dispute reason and contract terms specific to the payer.

Follows specific payer guidelines for appeal submission.

Escalates exhausted appeal efforts for resolution.

Works payer projects as directed.

Researches contract terms/interpretations and compiles necessary supporting documentation for appeals.

Escalates denial or payment variance trends to management for payer escalation.

Administration, Auditing and Compliance

Supports all health center external audits as necessary by providing financial reports and documentation as requested.

Reviews patient statements for accuracy, and makes corrections as needed.

Reviews patient returned address mailings and ensure timely resubmission.

Provides monthly billing/collections reports as needed.

Ensures billing is conducted in a manner that is consistent with overall department protocol, and in compliance with Federal, State and payor regulations, guidelines, and requirements.

Maintains filing system for all billing related document

Reviews Faxes directed to Billing Department.

Ensures confidentiality and security of all financial and patient files.

Attends meetings related to medical, behavioral health and dental billing as needed.

Culture of Service: 3 C’s

Compassion

Greets internal or external customer (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone and nonverbal language

Listens to internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring an understanding of the request and providing appropriate options or resolutions

Competency

Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered

Commitment

Takes initiative and anticipates internal or external customer needs by engaging them in the process and following up as needed

Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure prompt and effective response is provided

Safety

Ensure proper hand washing according to Centers for Disease Control and Prevention guidelines.

Understand and appropriately acts upon assigned role in Emergency Code System.

Understand and perform assigned role in health center’s Continuity of Operations Plan (COOP).

Other

Provides outstanding customer service to both internal and external customers using the Health Center’s 3C’s of service.

Participate in health center developmental activities as requested.

Own transportation required.

Other duties as assigned.

JOB SPECIFICATIONS

Education:

High School diploma required. Associates degree in related field is preferred.

Training and Experience:

At least two years of medical billing and/or denials management experience required.

Licenses and/or certifications:

Medical billing training and ICD-10-CM certification is required, coding certification a plus.

Job Knowledge and Skills:

Computer knowledge should include Microsoft applications (Word, Excel, Outlook), NexGen EHR, NexGen PM, and Dentrix EDR(a plus). Bilingual (English-Spanish) is helpful. Excellent oral and written communication skills are required to interact with external customers and vendors. Must be detail-oriented and possess good time management skills. Good organizational and decision- making skills are required to ensure that transactions are properly processed in accounting software and the EHR. Ability to work with multicultural and diverse population is required. 

Contact Responsibility:

The responsibility for internal and external contacts is important.

PHYSICAL REQUIREMENTS

This work requires the following physical activities: constant sitting, hand/finger dexterity, talking on the phone, and hearing/ visual acuity. Also it requires frequent walking and talking in person and occasional bending, standing, and stretching/reaching. Work is performed in an office setting.