With supervision from the Billing Manager, maintains the medical billing system including all charges and payments and ensures that all medical services provided by the clinic are properly billed and paid.
ESSENTIAL JOB FUNCTIONS:
Billing and Collection Duties
Responsible for timely transmissions of electronic and manual billing of medical services to ensure positive cash flow. Insurances include: FQHC Medi-Cal and Medicare and cross over, Medi-Cal Managed Care Alliance, Blue Cross, SB 1194, state programs, CHDP, SOFP, BCDEP, Healthy Families, First Care and Family Care, CALKIDS, HMO commercial and risk plans, PPOs and Fee-for-service Medi-Cal/Medicare (inpatients and radiology) and other third-party billing.
Responsible for posting payments for all insurances. Reconcile electronic posting for payments and manually post differences.
Communicates any problems with the electronic billing and payment posting system to the IT Department.
Responsible for processing self-pay billing and follow up on unpaid accounts.
Responsible for posting encounters for CHDP, SOFP, inpatient services and other third party billings. Prepare payments for providers for inpatient services.
Monitors and tracks patients’ accounts receivable aging reports. Makes any necessary adjustments for outstanding balances to resubmit claims or recommends bad debt write-off to Billing Manager.
Follows up on denied Federal Qualified Health Center (FQHC) Remittance Advice/Explanation of Benefits (RA/EOB) for Medi-Cal and Medicare claims, for all fee for service billings, and denied RA/EOB for private insurance and HMO commercial claims in a timely manner. Verify through online FSS system.
Reviews and analyzes overpayments from Medi-Cal for Medicare Part B and generates appropriate refunds.
Assists Billing Manager in addressing issues, questions, and problems raised by Billing Assistants, Billing Clerk and other staff in Patient Services regarding patient bills. Adjusts patients’ ledger/accounts as needed.
Reconciles all managed care capitation and fee-for-service reports for SB 1194.
Processes and inputs data into AHS’ billing system from Alameda Alliance and Blue Cross and Healthy Families scan forms that pertain to OB (pregnant) patients.
Assists other Billing staff in preparing claims for all fee-for-service and third party billing and follows up on denied/unpaid claims.
Assists Billing Manager in generating various billing reports as requested for Billing Manager to review and other areas of billing as necessary.
Represents the department as necessary in the absence of the Billing Manager.
Provides work direction to part-time Student Aides.
Keeps updated on new information related to Medi-Cal/Medicare, Managed Care, and other third-party billing; communicates information and trains other staff.
Works with doctors and nurses to correct any valid billing procedures and diagnostic codes on denied claims.
Attends meetings and training related to billing procedures that will impact Asian Health Services.
Patient Contact Duties
1.Assist clients or Patient Service Representatives with billing questions making referrals to eligibility workers, as appropriate.
2.Register new patients, do intake interview and assist eligibility worker to update patients’ financial status when needed.
3.Translate for providers, patients, and eligibility Medi-Cal workers, when needed.
4.Back-up cashier to input charges and payments when necessary.
5.Back-up Billing Clerk II, as needed.
6.May provide back-up support to Billing Manager and PSR as needed.
Meets regularly with the Billing Clerk II and the Eligibility Coordinator to discuss billing problems, other organizational issues affecting billing, and/or changes in third party billing requirements.
Monitors the impact of changes in third party billing policies and procedures on AHS communicating these to the Eligibility Coordinator and Billing Clerk II.
Serves as liaison with the Information Systems Manager to troubleshoot any software problems.
Works closely with the cashier to assure that the accounts receivable system is current and operating smoothly.
Attends staff and component meetings.
Participates on special AHS internal committees and task forces, as requested.
Performs other duties and projects as requested by the Eligibility Coordinator.
May monitor the impact of changes in third party billing policies and procedures at AHS, and communicate these to the Billing Manager and other members of the fiscal department.
May attend staff departmental meetings.
May participate on special AHS internal committees and task forces as requested.
Other duties that the supervisor might require.
May act as lead or team leader, providing work direction and guidance to others.
Entry Level: High School diploma and two years of work experience.
Intermediate Level: Associate's degree (A. A.) or equivalent from two-year college or technical school; three years’ experience in a clinic setting, two of those years in billing; or equivalent combination of education and experience. Experience with a computerized billing system.
Bilingual/bicultural in an Asian language preferred. Commitment to working in the Asian community, to community health care with familiarity with community health clinics preferred. CPT procedure and ICD-9 diagnosis coding preferred.
CERTIFICATES, LICENSES, REGISTRATIONS: HIPAA Training Certificate.