Revenue Cycle- Biller II

Company Overview: Eau Claire Cooperative Health Center, Inc. (dba Cooperative Health) is a leading community health center serving the Midlands of South Carolina since 1981. It is deeply rooted in its mission of providing accessible, high quality, compassion health care in the spirit of the Good Samaritan. The organization’s values of: treating each other with respect, putting people first, being excellent at what we do, promoting a collaborative work environment, improving community/population health, fostering innovative thinkers, and getting results, are core attributes of every employee at Cooperative Health.

Position Summary: The Revenue Cycle Biller II is primarily responsible for managing denials by resubmitting claims and following up with various insurance companies on reimbursement of unpaid claims. Responsible for daily review of accounts to identify the need for adjustments and/or corrections. Verification and reconciliation of insurance payments for claims previously billed in error. Responsible for Hospital Charge Entry. Responsible for processing Special Program claims. Identification and correction of EOB’s, and other Billing duties and tasks as assigned by Billing Supervisor and/or Revenue Cycle Director.

Principles Responsibilities:

• Daily review of accounts to identify the need for adjustments or guarantor responsibility.
• Process insurance write-offs for bad debt.
• Verification and reconciliation of insurance payments for claims previously billed in error.
• Serve as Receipt Poster back up.
• Work credit balances.
• Work bankruptcy and all other insurance correspondences.
• Work returned/uncashed checks worklist.
• Correct and resubmit denied claims.
• Daily review/correction/keying of hospital face sheets.
• Responsible for working daily denials claim buckets and outstanding self-pay accounts as directed by Revenue Cycle Supervisor.
• Responsible for validating CPT& ICD-10 codes to ensure that claims are reimbursable.
• Responsible for working various kick codes as it relates to payer guidelines.
• Review, verify, and submit Refund Requests to Supervisor for processing.
• Daily insurance verification as needed to include Medicaid and Medicaid managed care plans.
• Work from various reports as assigned by Supervisor.
• Responsible for taking incoming calls and responding to emails from patients and interdepartmental staff regarding patient balances and appropriate adjustments.
• Meet required daily claim quotas
• Processing bankruptcies, patient/insurance refunds, credit balances, collecting outstanding guarantor/insurance balances.
• Attend workshops, seminars, etc. as it relates to changes and updates to the process of accurately billing payers.
• Submit weekly updates via email regarding ongoing errors and/or trends of noncompliance.
• Responsible for other tasks and duties as required by Supervisor.

Competencies:

• Ability to embody the mission and vision of Cooperative Health.
• Excellent written and verbal communication and problem solving skills.
• Ability to communicate with people from a variety of socioeconomic and cultural backgrounds.
• Ability to prioritize, organize and carry out work assignments independently and efficiently.
• Ability to maintain appropriate degree of confidentiality.

Education & Experience:

• High school diploma or equivalent required. 
• Able to work at a consistent and efficient pace
• Must be familiar with billing guidelines of Medicaid, Medicaid MCO’s, Medicare and major private payers.
• Must be careful, detail-oriented, hard-working and have excellent follow through on assignments.
• Data entry proficiency with ability to use a calculator and accurate keyboard skills.
• Ability to prioritize and work independently
• Excellent organizational skills with ability to manage multiple billing projects and schedule tasks to meet all deadlines
• CPT & ICD-10 Knowledge.
• Sufficient computer competency, working skill set for Word and Excel.
• Must display professional attitude and maintain professional appearance.
• Must be able to follow written and oral instructions.
• Must be able to work as part of a team and foster the team concept.
• Ability to prioritize, meet deadlines and willing to work over-time as needed.
• Utilize and refer to all available resources to perform the job.
• Keep abreast of all insurance updates and changes that impacts the flow of claims.

Physical Demands:

• Prolonged periods sitting or standing
• Must be able to lift up to 25 pounds
• Be able to sit, stand, stoop, squat for extended periods of time throughout the day
• Standing or walking for extended periods throughout the day

Company Conformance Statement

In the performance of respective job assignments, all employees are required to conform with Cooperative Health’s:

• Board approved policies and procedures;
• Confidentiality and professional provisions;
• Compliance program; and
• Standards of conduct.

**Cooperative Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Cooperative Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfers, leaves of absence, compensation and training