MEDICAL BILLING SPECIALIST

Description

ORGANIZATION

The mission of Ravenswood Family Health Network (RFHN) is to improve the health of the community by providing culturally sensitive, integrated primary and preventative health care to all, regardless of ability to pay or immigration status, and collaborating with community partners to address the social determinants of health.

POSITION SUMMARY   

Under direct supervision, the Medical Billing Specialist (also referred to as Billing Clerk) is responsible for the preparation and submission of billing for all payers including self-pay patients, public program, and private third-party insurance. Additionally, conducts accounts receivable reviews and follows up on all unpaid accounts to ensure prompt payment.

DUTIES AND RESPONSIBILITIES

To be performed in accordance with RFHN Policies and Procedures

1. Reviews assigned encounter forms for accuracy and completeness before claims submission.
2. Returns incomplete forms to the appropriate clinical staff for correction.
3. Enters all visit and diagnostic codes from encounter forms into the practice management system on a daily basis.
4. Reviews batches of charges entered for errors prior to submitting.
5. Processes billing for services to all payors, including submission of electronic claims for public programs, hard copy claims on HCFA 1500s and UB 04s for private insurance, and hard copy statements for self-pay patients.
6. Maintains backup of original documentation, including encounter forms, copies of statements, and correspondence available for audit, upon request.
7. Receives remittance advices for third party billing; sends checks to accounting for deposit; reconciles remittance advices and posts payments in a timely manner to ensure cash flow.
8. Researches denials, unpaid or partially paid claims, and re-bills weekly to ensure prompt payment.
9. Attends training seminars sponsored by the State or other payors to keep up-to-date on billing and eligibility issues.
10. Responds to/answers all calls regarding patient accounts and billing questions.
11. Develops payment agreements with patients as outlined in the Billing and Collections Policy.
12. Uses templates and work-flow documentation tools effectively to ensure that encounters are completely documented as well as enabling the collection of data for statistical reports.
13. Attends meetings and participates in committees as requested.
14. Other duties as assigned and requested.

Qualifications

QUALIFICATIONS

• High school diploma or equivalent (GED) along with one year of billing experience in a health care organization required.
• Experience with medical and dental billing for an FQHC (Federally Qualified Health Center) highly desirable.
• Knowledge of billing practices required.
• Knowledge of CPT and ICD-10 coding and billing requirements for public programs and third-party payers.
• Knowledge of CDA and ICD-10 coding and billing requirements for public programs and third-party payers.
• Understanding of special billing modifiers.
• Knowledge of EPIC/OCHIN preferred.
• Bilingual Spanish/English or Tongan/English skills not required, but highly preferred to facilitate communication with patients.
• Familiar with a Windows environment and specifically Microsoft Excel.
• Familiar with data entry, use of a calculator, and software to create spread sheets such as Microsoft Excel.
• Ability to work effectively and cooperatively with other RFHN staff and patients. 
• Ability to examine documents for accuracy and completeness.
• Ability to communicate clearly.
• Ability to prepare records in accordance with detailed instructions.
• Up to date with COVID-19 vaccines per current CDC guidelines strongly recommended.

The pay range for this position is $23 to $38 per hour.  However, the final base pay will be determined upon a number of individualized factors such as (but not limited to) the scope and responsibilities of the position, job-related knowledge, skills, experience, education and certification levels, and departmental budget. We also consider internal equity with our current employees when making final offers.

Ravenswood Family Health Network is an equal opportunity employer.

Salary : $23 - $38