Central Billing Representative II

Central Billing Representative II

Under the supervision of the Central Billing Supervisor who reports to the Director of Revenue Cycle Management, the Central Billing Representative II is responsible for all patient accounts receivable functions as assigned. Reconcile, research, correct and submit third party claims and resubmit errors or denied claims. Communicate with insurance companies and government payers to resolve claim issues and ensure payment. Research and correct ICD-10, CPT coding, modifiers, revenue coding, occurrence codes and value codes as appropriate. Provide customer service to patients by researching billing issues and resolving the issues. Reconcile remittance advice and patient accounts and resolve discrepancies.

Essential Duties and Responsibilities:

• Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers.
• Follow up on claims denials, make appropriate corrections, obtain approvals and resubmit claims denials for payment; appeal denials through the payer required appeals process.
• Research unpaid claims; contact patients to obtain necessary information to assist with the claims process; secure payments or negotiate payment plans.
• Handle patient inquiries, complaints and customer service issues.
• Maintain current knowledge of regulations for Third Party Payers, Medicare, Medicaid and knowledge of claims coding and formats.
• Coordinate electronic patient statements monthly.
• Review credit balance reports and prepare refund requests for overpayments.
• Participate in billing Helpdesk customer support, by receiving, responding and documenting all incoming account inquiries including electronic, telephone and written correspondence related to billing issues.
• Review assigned outstanding A/R to identify problems with various insurance payers (i.e. Medicare, Medicaid, Commercial, Contracts and Self-Pay). Perform all routine and special follow-up on all assigned payer type accounts to affect collection of patient and insurance account balances.
• Review and resolve all EOB's including those without payment to initiate clean claim resubmission and claim reimbursement.
• Edit & submit insurance claims for fee for service and prospective payment system reimbursement.
• Follow up with outstanding A/R all payers and/or including self-pay and/or including resolution of denials.
• Communicate payment terms and establish agreed-upon payment plans for overdue patients.
• Monitor payment compliance with terms of established plans with patients and insurance plan provider representatives.
• Complete bad debt process based on FCCH procedure.
• Initiate & complete account adjustments to correct account balance and/or comply with contractual and sliding fee scale requirements.
• Responsible for all other duties as assigned.

Requirements:

Minimum Education and Experience:

• High school degree or GED.
• Two years in billing/claims experience in healthcare setting or FCCH billing externship.

Education or knowledge may be substituted for the experience requirement.

• Experience in a multispecialty clinic setting.

Preferred License/Certifications:

• Certified Coder (medical and/or dental).
• Billing Certificate, the result of graduation from a certified billing school.
• Coder and/or Billing Certificate may be substituted with demonstrated proficient knowledge of procedural CPT & ICD-10 diagnosis coding.

Knowledge, Skills, and Abilities:

• General knowledge of computerized practice management systems, preferably Cerner, Cerner Electronic Health Record System and E H R.
• Ability to learn billing and collection system within federally chartered community health centers (CHC) and RHI/UHI programs.
• Ability to communicate with tact and diplomacy with diverse groups of people including staff, providers, and insurance companies on behalf of the organization. Ability to display sensitivity to the patient population being served.
• Ability to work on a variety of assignments concurrently within established deadlines.
• Ability to work with others in a problem solving and team environment and to work alongside staff as needed.
• Knowledge of HIPAA as it relates to medical, dental & behavioral health billing.
• Position requires a high level of accuracy and attention to detail.
• Ability to communicate effectively, both orally and in writing.
• Ability to respond effectively to sensitive inquiries or complaints.
• Ability to work independently with minimal supervision.
• Proficient with computers and MS Windows software programs.
• Knowledge of Federally Qualified Health Care billing and reimbursement preferred.
• Working knowledge of CPT, DSM V and ICD-10 preferred.
• Knowledge of Medicare and Medicaid guidelines.
• General knowledge of UB04, HCFA1500 and Electronic and Paper claim forms.
• Knowledge and familiarity with compliance program. Cooperate fully and comply with laws and regulations.

Age of Patient Served:

N/A

Physical Characteristics/Working Conditions:

A person in this position must be able to prioritize and respond to the diverse demands of the position. There are frequent opportunities to relax from any physical exertion, change position in work activities or break from computer application tasks.

• Physical Effort and Dexterity: Good dexterity to operate personal computer and office equipment. Occasional lifting and carrying related to office duties.
• Machines, Tools, Equipment required to be operated: Capable of using office machines and personal computers for word processing, data entry and spreadsheet applications.
• Visual Acuity, Hearing, and Speaking: Must be able to read a computer monitor and outputs accurately. Must be able to clearly and accurately communicate for work, safety and compliance.
• Environment/Working Conditions: Work is mostly inside an office in a controlled environment. Normal office safety precautions and practices are required. Work regularly scheduled Monday-Friday. This description lists the major duties and requirements of the job and is not all-inclusive. Applicants may be expected to perform job-related duties other than those contained in this document and may be required to have specific job-related knowledge and skills.