Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years! We are one of central Texas’ largest professional medical groups with 25 locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/

PURPOSE

Performs all duties of department staff plus is responsible for electronic claims submissions, electronic remittances, refunds, adjustments, and coordinates and completes special day to day projects. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

Refunds

• Audits and processes refund requests per department guidelines
• Provides credit balance audit training to new staff
• Adjustments
• Audits and processes transaction adjustments from clinics per department guidelines

Electronic claims submission

• Submits electronic claim files to clearinghouse daily. Tracks accepted/rejected claims files
• Analyzes rejected claims and coordinates their repair & resubmission
• Maintains claim logs

Electronic remittance acceptance

• Tests and implements new payors
• Accepts, audits and processes files
• Researches and corrects variances

Adjustments

• Audits and processes transaction adjustments from clinics per department guidelines

Other

• Monitors and processes claims in Claim Edit and Retroadjudication Work Queues
• Assists in testing and development of new Epic work flows
• Processes and tracks bankruptcy information
• Performs A/R trend analysis on assigned health plans and specialties or business lines
• Works selected plan groupings or receivables projects and provides written reports
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on ARC SharePoint.

OTHER DUTIES AND RESPONSIBILITIES

• Provides assistance to coworkers and other unit staff as requested or assigned
• Able to meet performance standards in Registration, Posting and Insurance Follow-up.
• Keeps complete, accessible, dated files
• Provides workload statistic reports to supervisor
• Responds professionally and effectively to questions from all sources
• Attends required meetings, inservices and training
• Performs other duties as assigned.

QUALIFICATIONS

Education and Experience

Required: High school diploma or GED. Five (5) or more years of experience working with medical billing and coding in a practice or facility setting.

Knowledge, Skills and Abilities

• Knowledge of and experience in the effective use of CPT, ICD-10, and HCPCS coding.
• Experience working with accounts receivables to include effectively pursuing payments from insurance carriers and customers
• Knowledge of legislative and private sector third party regulations and guidelines
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Excellent computer and keyboarding skills, including familiarity with Microsoft.
• Excellent verbal and written communication skills.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.
• Skill in analyzing and interpreting financial records.
• Ability to have excellent attention to detail.

Certificate/License: None

Work Schedule: Monday - Friday 8:00am - 5:00pm