DESCRIPTION: Responsible for ensuring accurate billing, demonstrate knowledge of the revenue cycle process, possess leadership skills, critical thinking skills and thorough understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to train new team members and answer any billing related questions the team may have. In addition, the coordinator must demonstrate proficiency with billing systems to ensure all functionality is utilized for the utmost efficient processing of claims. The coordinator will serve as the lead liaison between the business office and providers to educate, audit the providers documentation and coding.
SUPERVISION: Directly supervised by the Business Office Manager / Director.
TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting. May require moving up to 25 pounds. Requires the use of office equipment, such as computer terminals, telephone and copiers.
Essential Functions And Responsibilities

• Maintain relationships with payor provider relations personnel to ensure GCHC is in good standing with all payors while understanding the latest billing guidelines for Medicare, Medicaid, MCOs, commercial insurances, and current programs.
• Serves as a team lead and a primary contact of billing operations for payors and Center's internal departments.
• Able to work and educate providers on billing guidelines, identify opportunities and support new providers during their orientation period.
• Display excellent management skills and a track record of meeting goals and deadlines.
• Promote effective working relations, work efficiently, and maximize team morale and its ability to meet goals and objectives.
• Generate daily, weekly, monthly reports including but not limited to unlocked charts, unpaid claims, and/or denial management to identify and trend denials, rejections and areas of opportunity
• Handle escalated or complex claims issues with Business Office Management team.
• Identify denial trends and work with Manager and Director of Business Office Operations to address the root cause and implement recovery strategies.
• Provide weekly updates on billing related to with Manager and Director of Business Office Operations and attend weekly huddle as requested.
• Maintain highest confidentiality.
• Adheres to all HIPAA guidelines/ regulations.
• Perform other duties as assigned to support Center's Clinic's Mission, Vision, and Values.

Secondary Functions

• Understand Business Office Processes, able to support business office personnel and represent Business Office Management when they are not available.
• Maintains a log of all electronically and/or hardcopy (paper) filed claims.
• Prints accounts receivable report and works the outstanding balances.
• Posts payments for all third-party claims to patient's account as per R&S or EOB.
• Runs receipts report to verify that all payments are posted by site and that the check amount reconciles with the computer total.
• Supports Claim Auditor in reviewing, correcting and appealing rejected claims and answers any associated correspondence from the claim processing.
• Researches and resolves outstanding claims and payment issues for all third-party billing and resubmits claims accordingly or initiating the appeal process if needed.
• Investigates all denied third party claims by rejection code and acts accordingly in coordination with the related provider, if applicable, to file appeals on rejected claims.
• Attend to patient complaints regarding services provided by business office, including account balance and statement inquiries.
• Follow-up on self-pay patient AR, authorized payment plans and returned mail.
• Assists in the completion of appropriate, accurate and timely Center and provider enrollment and credentialing with Medicare, Medicaid, and all third-party payers contracted with the Center.

Minimum Qualifications

• High School Diploma or GED required.
• Minimum of five (5) years of experience in a healthcare environment;
• Previous experience in a medical office setting and/or experience with an Electronic Medical Record a plus.
• Excellent organization and time management skills.
• Ability to work well with medical providers while providing information as needed.
• Strong written and verbal communication skills and strong analytical skills required.
• Will need coding certification - or interest in completing in the first 6 months

Skills And Abilities

• Ability to learn quickly, build and maintain long term relationships and work with minimal supervision.
• Understanding of medical terminology and insurance laws/guidelines.
• Customer service driven.
• Collaborate with departments within the center as well as payors to resolve billing inconsistencies and errors.
• Must be able to carry out verbal and written instructions.
• Must be computer literate.
• Ability to maintain patient confidentiality.
• Ability to effectively communicate verbally and in writing.
• Ability to work flexible hours.
• Knowledge of clinical and operational functions performed in a primary care setting.
• Knowledge of individual as well as group dynamics and community organizations.