General Summary

Performs a variety of complex clerical and accounting functions for patient billing, including verification of invoice information, maintenance of third party billing records, and resolution of a variety of problems. Follows up on submitted claims and patient billing; resubmits claims or resolves problems. Works with others in a team environment.

Primary Responsibilities

1. Processes claims to patients and other payers and maintains supporting documentation files.

2. Researches and responds in person, by telephone, or in writing to patient or insurance carrier inquiries regarding billing questions.

3. Follows up on submitted claims; monitors unpaid claims, initiates tracers with EHR software; re-file claims as necessary with standard billing cycle time frame, either electronically, on paper, or on insurance provider web portals.

4. Posts and reconciles payments to patient account inquiry; checking each insurance payment for accuracy based on contracted fees.

5. Identifies and bills secondary and tertiary insurance companies.

6. Reviews accounts receivable and make recommendations to supervisor on delinquent accounts.

7. Reviews and analyzes patient records; keeps track of patient data over unpaid multiple visits.

8. Follows up on appeals, denials, and rejected claims with insurance carriers.

9. Maintains billing/filing records in accordance with established protocol.

10. Ensures strict confidentiality of financial records as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

11. Ensures that recorded CPT/ HCPCS/ ICD codes reflected in providers documentation comply with insurance carriers, federal, and state guidelines.

12. Maintains knowledge of ICD/CPT/HCPCS coding and any FQHC specific coding requirements necessary to ensure best practices are applied in the revenue cycle.

13. Performs other duties as assigned.

14. Promotes and adheres to CACOST core values (Accountability, Excellence, Integrity, Quality and Teamwork).

Work Experience

Minimum of one year experience in medical office setting.

Three years of prior employment experience in medical billing.

Multi-speciality group coding and billing

Education/Certifications/Licensure

High school degree or equivalent;

Medical Coding Certificate; RHIT or CPC by AAPC or AHIMA license; meet state licensure requirements.

Skills

Computer skills and experience in maintaining automated recordkeeping systems

Knowledge of Electronic Medical Record software; Microsoft Office Suite and Google Drive.

Good communication skills, written and oral, are necessary.

Ability to work independently or as an active member of a team.

Ability to multitask, prioritize, and manage time efficiently.

Accurate and precise attention to detail.

Goal-oriented, organized team player.

Prefer bilingual in English and Spanish.

Knowledgeable about government regulations and insurance payer policies on healthcare and ensure that coding meets acceptable standards.

Understanding of medical terminology, anatomy and physiology.

Physical Requirements

Light to medium physical duties include sitting, standing, walking, reaching, bending, hearing, and talking for up to eight(8) hours a day. Must have good vision; with or without corrective lenses. Must be able to lift twenty (20) pounds. Lifting will be primarily confined to occasional on premises lifting of boxes of office supplies and minor office equipment.