Job Description

Job Summary:

The position will be responsible to process and submit accurate and timely claims to payers, analyze and research unpaid claims and assist in the resolutions of denial, partial payments and payment variances.  The position will work with the manager and clinic leadership to ensure assigned accounts are paid in a timely manner.

Duties/Responsibilities

  • Assists in the daily medical billing activities to include basic coding, data entry, patient registration and claim review in an effort to resolve all patient inquiries and/ or disputes.
  • Collaborates with clinic leadership/staff to obtain needed information for processing claims
  • Responsible for the processing of medical claim insurance payments, patient payments (including setting up payment plans), and applying insurance adjustments through data-entry in the EHR.
  • Responsible for managing the use of adjustment codes, contractual adjustment codes, non-contractual adjustments codes, and bad debt codes.
  • Responsible for managing low reimbursements and denials to determine when a reimbursement requires appeal.
  • Responsible for assisting with billing secondary claims and EOBs that need follow up.
  • Research and processes insurance denials, unpaid claims or underpaid claims reviewing documentation and insurance/contract/coding guidelines. This process includes written appeals when appropriate and/or contacting the insurance. Additionally, inputs internal and external review decisions including charge adjustments, corrections, proper payment, and resubmission of claims in the claims system.
  • Responsible for reviewing and correcting claims that are suspended by the billing system. Assists in identifying accurate insurance. Updates/modifies insurance information with redirection of charges when appropriate.
  • Comply with and adhere to all regulatory compliance areas, policies, and procedures (including HIPAA and PCI compliance requirements)
  • Provide excellent customer service to patients and clinic staff when answering calls.
  • Identifies, researches, and prepares refunds to patient and insurances.
  • Supports and assists in the follow up and identification of billing issues for outstanding claims.
  • Remains current on billing and coding procedures and changes.
  • Ensures accurate reimbursement is being received for services rendered.
  • Balances daily batches and reports. Researches and corrects discrepancies.
  • Processes billing questions from insurance carriers and patients via telephone and face-to-face inquiries.
  • Handle all patient refunds and documents accordingly.
  • Travel may be required depending on business needs.
  • Hours may vary and be outside of normal office hours depending on business needs.
  • Other duties as deemed necessary to include finance responsibilities.

Qualifications/Skills

  • Strong oral and written communication skills.
  • Strong organizational skills.
  • Ability to work with minimal needed oversight and supervision
  • Ability to perform multiple duties in a fast pace and high-volume environment.
  • Demonstrated ability to interact effectively with peers and subordinates of all levels.
  • Proficiency with Microsoft Office suite (Excel, PowerPoint, Word, Outlook)
  • Demonstrated experience in Practice Management Systems.
  • Recognizes possible solutions to problems and is able to explain issues and propose solutions.
  • Maintains customer confidence and protects operations by keeping information confidential.
  • Contributes to team effort by accomplishing related results as needed.
  • Strong customer service orientation.
  • Able to work alone and with a team.
  • Strong follow-through.

Education and Experience

  • High School diploma or GED required
  • CPC (coding) license preferred
  • 3 years minimum experience required, specifically medical office/physician billing and insurance claim follow-up and denial management
  • Ability to speak Spanish, a plus