Summary:
Responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and collection specialist must possess critical thinking skills and understanding of Medicare, Medicaid eligibility requirements as well as commercial insurance payer payment methods to correctly record contractual adjustments base on payer contracts or government regulations. In addition, the medical billing and collection specialist must demonstrate proficiency with the billing system to ensure all functionality is utilized for the utmost efficient processing of claims by performing the following duties.
Duties and Responsibilities include the following. Other duties may be assigned.
1. Maintains responsibility for charge and payment entry within Electronic Health Record.*
2. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/ claim adjudication.*
3. Maintains responsibility for correcting, completing, and processing claims for all payer codes.*
4. Analyzes and interprets that claims are accurately sent to insurance companies.*
5. Performs follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports.*
6. Processes appeals online or via paper submission.*
7. Assists in reconciling deposit and patient collections.*
8. Assists with billing audit related information.*
9. Processes refund requests.*
10. Attends billing meetings/ workshops when needed.*
11. Communicates with billing and credentialing coordinator to identify and resolve audit review issues.*
12. Processes billing calls and questions from patients and third-party carriers.*
13. Answers/responds to correspondence related to patient accounts. Is available to answer billing and changes related inquiries by patients, staff, Managed Care Organization, etc.*
14. Communicates daily with internal and external customers via phone calls and written communications.*
15. Researches, records findings, and communicates effectively with Manager to achieve optimum performance.*
16. Maintains patient confidence and protects medical office operations by keeping patient information confidential.*
17. Contributes to team effort by accomplishing related results as needed.*
18. Promotes effective working relations and work effectively as part of a team to facilitate the department’s ability to meet its goals and objectives.*
19. Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to insure a professional, responsible and courteous environment.*
20. Performs other duties as assigned to support MAPP Mission, Vision, and Values.*
21. Produces and interprets EMR and Clearinghouse EBO reports.
22. Reconciles deposits and maintains deposit records.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Language Ability:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Math Ability:
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Reasoning Ability:
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.
Computer Skills:
To perform this job successfully, an individual should have knowledge of word processing software, spreadsheet software, Record hours worked in payroll system, Email interface, merchant banking interface, EMR, Clearinghouse, Insurance Payers, verify eligibility via EMR and others as needed.
Education/Experience:
High school diploma or general education degree (GED); CPC, SGPCE preferred but not required and less than one year related experience or training; or customer service experience.
Knowledge, Skills, and Other Abilities:
· Attention to detail
· Customer Service
· Oral and Written Communication skills
· Team Player
· Professionalism
· Ability to defuse complicated or stressful situations
· Ability to maintain confidentiality of patient information and company records
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is occasionally required to stand, walk, and stoop, kneel, crouch or crawl. Specific vision abilities required by this job include close vision, distance vision, depth perception, and ability to adjust focus.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally exposed to fumes or airborne particles.
The noise level in the work environment is usually moderate.
Job Type: Full-time
Pay: From $20.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible spending account
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
