General Description: Provide front-line medical billing support to billing department and other staff as appropriate. Work Denials and Appeals in a timely and efficient manger ensuring the compliance of meeting timely filing deadlines.
Reports To: Medical Billing/Coding Supervisor & Departmental Director
- Medical Billing, two to five years of experience required.
- High school diploma or equivalent required.
- Experience with compliance, working medical billing denial & appeals, as well as experience in registering patients and entering/reconciling charges in a medical billing system as needed.
- Ability to establish and maintain effective working relationships with third party payers, individuals seeking assistance, and the general public.
- Professionalism in behavior and appearance
- Ability to prepare financial and statistical billing reports as needed.
- Computer literacy and PC application skills
- Ability to type at least 35 WPM
- Ability to work within a team as well as work independently as need.
- Problem- solving skills to research and resolve discrepancies, denials and appeals.
- Current knowledge and understanding of medical terminology.
- Effective communication abilities for telephone contacts with insurance payers to resolve issues.
- Customer Service skills to include a calm demeanor for interacting with patients regarding medical claims and payments; including communicating with patients and family members of diverse ages and back grounds.
Principal Responsibilities and Duties:
- Responsible for reviewing, processing & submitting medical claims using Epic billing software for numerous medical payers including the submission of electronic and paper claims processing/submission.
- Review medical & patient bills for accuracy and completeness, obtaining any missing information before submission.
- Familiar with CPT codes, ICD-10 codes, HCPCS II codes based on documentation, payer requirements and billing policies.
- Compile, complete, verify, correct and/or register insurance information for new and existing patients.
- Process sliding scale discount applications, set up payment plans and process self-pay medical payments over the phone for patient business matters.
- Follow up on unpaid claims within standard billing cycle time frames.
- Work with Supervisory staff to resolve reimbursement issues by calling insurance companies regarding any discrepancy in payments if necessary.
- Identify and bill secondary or tertiary insurances and see opportunities to reduce denials and enhance revenue.
- Research and appeal denied claims for all payers.
- Answer all patient, insurance or attorney telephone inquiries pertaining to the assigned accounts.
- Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid and other payer requirements.
- Maintains library of information/tools related to documentation & billing guidelines.
- Maintains confidentiality of account information.
- Concurrently bills, resolves and records noted billing issues and provides ongoing feedback to Billing Department Supervisor & Director.
- Stays up to date with billing compliance with FQHC guidelines for billing of medical services. Education includes the Evaluation and Management coding requirements.
- Identifies problems related to assigned duties and proposes solutions.
- Work with Medical Billing Supervisor, Departmental Director, EHR training staff and/or Super user(s) of EHR/EPM system, to become proficient in all aspects of learning and using the Epic/Ochin practice management system correctly for your assigned job duties.
- Performs other duties as assigned by the Medical Billing/Coding Supervisor or Departmental Director.
This position requires the ability to use a computer workstation, operate a key board and sit for 8 hours a day within an onsite office setting.
From time to time, this position requires the ability to work long and arduous hours.