Medical Biller

POSITION SUMMARY

Under the supervision of the Billing Manager this position serves in multiple capacities. The employee in this position is responsible for ensuring the accurate, and timely billing, and collection of all claims. This position works closely with insurance companies and the Revenue Manager for insurance reimbursements. When applicable, this employee specifically works closely with contractual third party billing agencies in processing insurance and medical program reimbursements. This is highly specialized administrative and financial support work. The employee in this position is responsible for and held accountable for maintaining patient/client and sensitive organizational management information confidentiality.

ESSENTIAL FUNCTIONS & KEY COMPETENCIES

n Demonstrates a strong business acumen as well as substantial knowledge and expertise in claims and billing procedures. Analyze, synthesize and communicate complex data, clinical information, business needs and related issues in an accurate, objective and straightforward manner.

n Promptly and professionally answers, screens, and processes medical service requests and telephone inquiries with strict adherence to confidentiality policies.

n Refers patients to the appropriate staff, according to patient request per established protocols. i.e. triage, medical records, patient care coordinators, case management and navigation staff.

n Attends/completes all assigned training through learning management system and other resources as required.

n Meets department benchmarks and or quality indicators as monitored through audits and or recordings.

n Supports organizational changes, demonstrates flexibility in providing coverage as needed during times of high volume or staff shortages.

n Responsible for the timely posting of charges, payments and adjustments for medical services for all provider specialties and payer types, utilizing the patient encounter information as directed by physicians and medical records notes.

n Have a comprehensive understanding of coding rules and regulations by CMS, AMA, ADA and Medicaid.

n Provides timely follow up of accounts receivable financial classes. Works denials from insurance carriers. Discusses accounts with patients and/or responsible parties. Works self-pay balances after insurance in accordance with credit and collection policy.

n Must have an excellent understanding of all policies and procedures.

n Completes CPT/ICD10/HCPCS coding for hospital and office encounters. Demonstrates coding development and expertise to professional clinical staff as well as Finance department. Conducts coding audits, reports feedback in compliance with action plans.

n Ensures that correct coding practices are utilized.

n Demonstrates a high level of problem-solving skill.

n Assists the Quality Assurance Manager and performs duties in various improvement programs including participation in quality assurance and improvement program, and patient centered medical home transformation.

n Performs other duties as assigned.

PRIMARY TASKS AND DUTIES

n Submit the service claims to the appropriate health plans on a daily basis, review all denials for complexity, make corrections and resubmit claims within 30 days of the denial received date.

n Complete claim forms, submit bills and claims, perform quality control procedures on all claim forms and detail bills to ensure accurate billing.

n Contact vendors regarding denials or benefit coverage.

n Verify insurance benefits.

PRIMARY ACCOUNTABILITIES

Achieve Results

n Ensure timely and accurate coding, billing and collection of claims. Ensure that the billing and collection processes Meet or exceed the organization’s financial and operational goals.

n Ensure timely and accurate problem resolution between the organization and its patients, payor sources, as well as vendors, contractors, and other related business entities.

Operational Excellence

n Ensure the billing processes and collection mechanisms meet or exceed all requirements for internal controls as well as those from all third party payors.

n Ensure all billing processes and collection functions are compliant with all internal policies as well as state, local, and federal laws, regulations, regulatory and/or best practices.

n Ensure all billing and collection efforts contribute to a positive patient experience.

Relationships

n Develop and ensure effective, positive relationships within and among the billing staff, as well as with other disciplines within the organization.

n Develop and ensure positive working relationships with patients, contractors, vendors, third party payor resources and related entities.

Leadership & Stewardship

n Uphold and consistently represent the values, mission, and policies of the organization at all times.

POSITION REQUIREMENTS

EXPERIENCE: Previous appropriate experience is a significant factor in selection of the Professional Coder. Demonstrated “skilled” experience and expertise in billing and record keeping. Demonstrated experience and significant knowledge of contract insurance, HMO’s, PPO’s, Medicare, etc. Significant computer/spreadsheet experience and demonstrated knowledge of PC files and related computer workings required. Demonstrated analytical skills and aptitude for solving problems. Demonstrated experience with providing quality customer service in difficult situations. Demonstrated high level of communication and customer service skills.

EDUCATION: A Bachelors Degree form an accredited university or college is preferred. Advanced education in accounting, business, or related field strongly preferred. Certification in professional coding (CPC) preferred. Prior experience may be considered. Must complete continuing education requirements.

SKILLS: Thorough knowledge of all program operations and procedures. Good management skills. Excellent oral, written and interpersonal communication skills. Ability to manage emotions and anxiety. Ability to operate all equipment used in performing office services.

PROBLEM SOLVING: Problem solving is a factor in this position.

DECISION MAKING: Decision making is a factor in this position.

ACCOUNTABILITY: Responsible to maintain collections and receivables and bring issues to the attention of the Chief Operations Officer and the Chief Financial Officer. Employee is responsible for reading, knowing and following policies, procedures and protocols from Centers for Medicare & Medicaid Services and guidelines in manuals dealing with specific programs as assigned.

Private Health Information: Protected Health Information or PHI means any information (including demographic information collected from an individual), whether oral or recorded in any form or medium. This position requires regular access to protected health information. The Billing Manager position requires complete access to all PHI that is necessary to carry out vital job functions as outlined in this description. The Billing Manager is obligated to divulge the minimum necessary PHI to carry out essential functions of the position.

This position requires the employee to sign a confidentiality agreement as all programs under the Community Health Center in Cowley County, Inc. are required to be HIPAA compliant.

WORKING CONDITIONS: Physical effort is required. The employee in this position must be able to meet deadlines under excess pressure.

PHYSICAL ABILITY: While performing the duties of this job, the employee is regularly required to sit, stand, walk, stoop, kneel, or crouch. Ability to interact with computer screen for up to six hours at a time (visual acuity required). Must have manual dexterity for use of keyboard. Ability to remain stationary for periods of up to four hours. Ability to communicate via phone, mail and in person to resolve disputes, solve problems, etc. Cognitive skills to analyze, calculate, problem solve issues related to invoices, billing, and other relevant matters associated with the invoicing and billing processes. Normal overtime/extended work hours. The employee frequently is required to reach with hands and arms; use hands to handle or feel; and talk or hear. Ability to walk, bend, stoop, reach, and lift fifty (50) pounds is required. Ability to express or exchange thoughts and ideas by means of written and verbal communication is required. Conveying and receiving detailed important verbal instruction to and from other workers and senior management is necessary. Ability to operate personal automobile, due to services being provided at various sites in the county, as well as, the need to attend job-related in-services and workshops held throughout the state. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SUPERVISORY RESPONSIBILITIES: The Professional Coder does not directly supervise other staff, but indirectly may provide process guidance.

ATTENDANCE STANDARDS: Consistently be at work and communicate appropriately any attendance issues with the Billing Manager as per policy. Consistently at their work station at the appropriately scheduled time. Does not abuse breaks and/or departure times.

LANGUAGE SKILLS: Has the ability to read and comprehend simple instructions, short correspondence, and memos. Has the ability to write simple correspondence. Has the ability to effectively present information in one-on-one and small group situations to senior management and other employees of the organization.

MATHEMATICAL SKILLS: Has the ability to add, subtract, multiply, divide, and calculate figures. Has the ability to analyze financial results from operations, complete financial and cash flow forecasts

REASONING ABILITY: Has the ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

PERSONAL RELATIONS: Continual contact with fellow employees, contractors, other local agencies, local medical professionals, consultants and the general public. Must be able to establish and maintain effective working relationships with all of the above.

OTHER REQUIREMENTS: Valid Kansas Drivers License, use of personal automobile and certificate of liability insurance from automobile insurer.

WORKING RELATIONSHIPS: Reports to: Chief Operations Officer

Job Type: Full-time

Pay: $20.00 - $21.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift

Ability to Relocate:

• Winfield, KS 67156: Relocate before starting work (Required)

Work Location: In person

Salary : $20 - $21