Billing Representative II

Overview

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.

• 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 denials for payment; appeal denials through the payer required appeals process.
• Research unpaid claims; contact patients to obtain necessary information to assist 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 over payments.
• 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 EOBs 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 for 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.

• MINIMUM EDUCATION AND EXPERIENCE
• High school degree or GED.
• Two years in billing/claims experience in healthcare setting or FCCH billing externship.
• Experience in a multispecialty clinic setting.
• Education or knowledge may be substituted for the experience requirement.
• 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 CPT & ICD-10 diagnosis coding.

• General knowledge of computerized practice management systems, preferably Cerner, Cerner Electronic Health Record System and EHR.
• 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.
• Abi…