Key Responsibilities
Billing & Claims Management
- Prepare, review, and submit electronic and paper claims accurately and timely using Athenahealth.
- Ensure claims are billed according to FQHC guidelines, payer contracts, and CMS regulations.
- Monitor claim edits, rejections, denials, and underpayments and resolve issues promptly.
- Follow up on unpaid or delayed claims with insurance companies, Medicaid, Medicare, and managed care organizations.
- Process corrected claims, appeals, and reconsiderations as needed.
- Review daily billing reports and work queues within Athenahealth.
Accounts Receivable Management
- Maintain and reduce aging accounts receivable balances.
- Perform detailed account research and resolution for outstanding balances.
- Identify billing trends and recurring issues impacting reimbursement.
- Communicate reimbursement issues to leadership with recommendations for improvement.
Payment Posting & Reconciliation
- Verify and reconcile insurance payments, adjustments, and patient payments.
- Assist with identifying payment discrepancies and contractual variances.
- Ensure accurate posting of ERA/EOB payments.
- Support daily and monthly reconciliation activities.
FQHC Compliance & Regulatory Requirements
- Maintain knowledge of FQHC PPS/APM billing requirements.
- Ensure compliance with HRSA, CMS, Medicaid, Medicare, and commercial payer regulations.
- Monitor updates to billing regulations and payer policies.
- Assist with audits and compliance reviews as requested.
Collaboration & Communication
- Collaborate closely with providers, clinic managers, coders, front desk staff, and leadership to resolve billing issues.
- Provide education and feedback regarding documentation deficiencies impacting reimbursement.
- Participate in revenue cycle meetings and process improvement initiatives.
Qualifications
- High school diploma or GED required.
- Associate degree in Healthcare Administration, Medical Billing, Coding, or related field preferred.
- Minimum of 3 years of medical billing experience required.
- Minimum of 2 years of FQHC billing experience strongly preferred.
- Direct experience using Athenahealth (Athena) required.
- Experience billing Medicaid, Medicare, Managed Care, and Commercial Insurance plans.
- Experience with denials management and accounts receivable follow-up.
Preferred Certifications
- Certified Professional Biller (CPB)
- Certified Coding Specialist (CCS)
- Certified Professional Coder (CPC)
Key Competencies
- Strong understanding of FQHC billing regulations and reimbursement methodologies.
- Knowledge of CPT, ICD-10, HCPCS, and modifiers.
- Proficiency in Athenahealth billing and reporting tools.
- Strong analytical and critical thinking skills.
- Excellent organizational and time management abilities.
- Ability to maintain confidentiality and HIPAA compliance.
- Strong verbal and written communication skills.
- Ability to work independently and collaboratively in a fast-paced healthcare environment.
Performance Expectations
· · Maintain timely claim submission rates.
· · Achieve accounts receivable goals established by leadership.
· · Reduce denial rates and improve clean claim percentages.
· · Ensure compliance with payer and FQHC billing requirements.
· · Maintain accuracy in payment posting and account reconciliation.
About HAPPI Health
HAPPI Health is a mission-driven community health organization committed to expanding access to quality care for the people of Huntsville, Madison, and Morgan County. As we continue to grow, we're looking for a sharp, experienced In-House FQHC Billing Specialist to join our team and play a key role in strengthening our revenue cycle performance — while making a real difference in the communities we serve.
Position Overview
The In-House FQHC Billing Specialist is responsible for managing all aspects of Federally Qualified Health Center (FQHC) billing and reimbursement processes utilizing Athenahealth (Athena) practice management and electronic health record systems. This position ensures timely and accurate submission of claims, payment posting, denial management, accounts receivable follow-up, and compliance with federal, state, and payer regulations.
The ideal candidate will possess strong knowledge of FQHC billing requirements, Medicaid and Medicare regulations, managed care billing, and experience working directly within Athenahealth systems.
Benefits:
- Professional development assistance
Work Location: In-person
Equal Opportunity Employer Statement
We are an equal opportunity employer and value diversity at all levels of the organization. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic.
