Medical Biller 2 at Central… · Santa Fe…

INTRODUCTION:

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) committed to the Triple Aim as described by the Institute for Healthcare Improvement. Improving the US health care system requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations, and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.

SUMMARY:

Responsible for correcting, completing, processing claims and delegating any other tasks to the billing department team. Generate reports from EMR and Power-Bi to ensure proper and timely billing and revenue posting.

ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following functions:

• Under the supervision of the Revenue Cycle Manager, claims are submitted in accordance with payors timely billing requirements.

• Submit accurate and complete claims to various payers on a timely basis, both paper and electronic (daily).

• Post and reconcile patient payments.

• Post charges and adjustments to patient accounts for all payors.

• Manages and directs the retrieval, approval and correction of claims as they come through the EHR system.

• Interpret and review insurance EOBs, determine claim denial reasons and follow-up with corrections and pursuing proper course of action.

• Ensure complete filing and follow-up of encounter data submission to health plans, IPAs, and other payors, i.e. secondary/crossover billing.

• Ensure that all denials are corrected, re-billed or adjusted timely.

• Work with the Revenue Cycle Manager to ensure that any new programs and services are billable.

• Enter cash receipts if needed and assure correct allocations, distribution in accordance with the established protocol.

• Billing productivity numbers must be met weekly (375+ claims per week).

• Weekly errors must be at a 2% or below

• Maintain and review “To Be Billed” accounts. Make sure they have been completed and billed on a weekly basis.

• Stay in communication with the Revenue Cycle Manager on inventory and any outstanding claims.

• Assist the Revenue Cycle Manager and other clinics in closing and balancing month closing no later than the 10th of every month.

• All To Be Billed Charges must be billed (including older dates).

• Verify that there are no outstanding claims left for the prior month.

• All other assignments as directed by the Revenue Cycle Manager.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

• High School graduate or GED with 2+ years’ experience in handling Medical Billing and account receivables in a similar set up or related field.

• Some training or background in ICD-10/CPT codes.

• Some ability to understand and practice bookkeeping and accounting terminology.

• Knowledge of medical/dental terminology and billing practices.

• Must have experience using the practice management system of an electronic health system. (IMS preferred)

KNOWLEDGE, SKILLS, and ABILITIES:

• Ability to work under pressure and in time sensitive situations.

• Ability to handle multiple tasks and be highly organized and detail-oriented

• Understanding of community-based organizations

• Knowledge of CPT and ICD10 codes.

• Experience at Federally Qualified Health Center required

• Must have accuracy, excellent analytical, problem-solving, and time management skills, and possess strong organizational skills.

• Communicate effectively with providers, other staff and outside vendors.

• Knowledge of all programs offered by CNCHC.

• Promotes and believes in CNCHC’s mission statement.

• Ability to relate to the public regardless of ethnicity, religion and economic status.

• Must have a high level of accuracy, excellent analytical, problem solving and time management skills, and possess strong organizational skills.

• Ability to adapt to changes in clinic setting and insurance payors requirements.

Policy

Punctual and regular attendance is an essential responsibility of each employee at CNHF. Employees are expected to report to work as scheduled, on time and prepared to start working. Employees also are expected to remain at work for their entire work schedule. Late arrival, early departure or other absences from scheduled hours are disruptive and must be avoided.

This policy does not apply to absences covered by the Family and Medical Leave Act (FMLA) or leave provided as a reasonable accommodation under the Americans with Disabilities Act (ADA). These exceptions are described in separate policies.

WORK ENVIRONMENT

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 qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.

CONFIDENTIALITY

Maintains patient, employee, and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

1. AGREEMENT AND ACCEPTANCE

2. I HAVE READ THE ABOVE JOB DESCRIPTION AND FULLY UNDERSTAND THE REQUIREMENTS SET FORTH AND WILL PERFORM ALL DUTIES AND RESPONSIBILITIES TO THE BEST OF MY ABILITY.