SUMMARY:Reporting to the Revenue Cycle Manager, this task-oriented individual is responsible for ensuring the organization meets its desired patient revenue goals by maintaining weekly claims processing, monitoring aging reports, monitoring unprocessed/denied claims and collections of private pay, insurance, and fee for service claims. ESSENTIAL DUTIES AND RESPONSIBILITIES: The following are indicative of the essential functions required to perform this job successfully. Other duties may be assigned by ma11agement. Accurate electronic charge entry which includes review of CPT codes, ICD-9 codes, HCPCS codes, patient infonnation, insurance information, provider and charge information Maintaining claims processing productivity through accurate and complete claim submissions Ability to analyze EOB denials and determine steps necessary to correct claims. Ensures ongoing management of the AR based on the organization's goal. Including monitoring of aging reports, timely follow up on insurance claim status, resolution of denials/rejections, re submission of claims, and file appeals Respond to inquiries from insurance companies, patients and providers Ensure compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. Assist with auditing data within the practice management system for accuracy and validity. Perform additional duties as requested by Supervisor or Management team. Maintains current knowledge of state and federal billing requirements and regulations Responsible for the maintenance of patient confidentiality and adherence to Patient Rights and Responsibilities, as issued in the New Hire Orientation Adheres to all MWCHC policies and procedures Possesses the ability to get along with co-workers, patients and visitors Perfonns all other duties as assigned by management QUALiFiCATIONSIREOUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. DUCATIONIEXPERJENCE: Two years of college or the equivalent combination of training and work experience beyond twelve years of school required. Must have a minimum of2 years of billing/coding experience for a health care facility, Community Health Center preferred. Solid knowledge of medical/billing terminology, ICD-10 and CPT codes, diagnostic and procedural coding, Medicare, TennCare and third-party billing required. Medical Billing & Coding Certification preferred, but not required. Electronic medical record proficiency required, NEXTGEN system experience preferred. FQHC experience a plus. LANGUAGE SKILLS: Ability to read, analyze and interpret complex documents. Ability to respond to the most sensitive inquiries/complaints. Ability to make effective and persuasive, tactful presentations to patients regarding their accounts and payment. Ability to communicate with all levels of the organization is required. TECHNICAL SKILLS: Must possess excellent organization skills and be able to work in a high production environment. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio and percent. Ability to compute basic percentages. Previous advanced experience with Microsoft Word, Excel, PowerPoint, and Internet Explorer, or another web browser, is required. Ten key speed and accuracy, preferred. Excellent organizational skills with acute attention lo detail are required. REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule format. OTHER SKILLS AND ABILITIES: Must be able to work in a fast paced, team- oriented environment. Requires excellent communication, organizational and interpersonal skills. Must possess the ability to work efficiently and effectively with all levels of the organization, particularly patients from varying economic backgrounds. Ability to use fax machine, office copier, and computer required. Ability to concentrate for extended periods of time, memory for detail, and speed and accuracy in numerical computations is necessary. Must be patient-focused with excellent analytical and problem-solving skills. PHYSICAL DEMANDS: The physical demands 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 individuals with disabilities to perform the essential functions. While performing the essential functions of this job, the employee is regularly required to sit; use hands to finger, handle or feel objects, tools, or controls; talk and hear. Individual may occasionally lift up to 15 lbs. Repetitive motion is required. Specific vision abilities required of this job include close vision, peripheral vision, color vision, depth perception and the ability to adjust focus. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Works in a typical office/clinical environment. The noise level in the work environment is usually moderate. May require potential exposure to at-risk health conditions, blood borne pathogens, chemicals, medications, X-Ray, 02 and other potential health and/or safety hazards typical of a medical environment. Employee is required to be aware of and in compliance with MWCHC, state and federal OSHA regulations as they pertain to these factors. and others typical of a clinical setting.
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