Equitas Health is a not-for-profit community-based healthcare system founded in 1984 and now one of the nation’s largest HIV and lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-serving healthcare organizations in the U.S. It serves more than 67,000 individuals each year through its diverse healthcare and social service delivery system focused around: primary and specialized medical care, pharmacy, behavioral health, HIV/STI treatment and prevention, research, advocacy, and community health initiatives.
ESSENTIAL JOB FUNCTIONS:
Essential functions of the job include, but are not limited to, data entry, typing, coding, filing, sorting, utilizing a computer for data entry, conducting research, attending meetings, drafting and distributing reports, interacting with others, reconciling data, creating and updating spreadsheets, and coordinating multiple schedules. Communicating with others is an essential job function.
This area is responsible for analyzing and reviewing professional medical records: by accurately coding and abstracting professional medical records for the purpose of reimbursement, research and compliance with federal regulations by diagnosis, assignment of ICD-10, modifiers and CPT codes for outpatient Primary care and Specialty clinical services as indicated. Also responsible for researching new diagnoses and/or procedures for code assignments and performing related miscellaneous duties as assigned. This position also will be responsible for various business office tasks to ensure efficient billing, follow up, payment posting, and patient statement activities in order to maximize revenue. This position reports to the Director of Healthcare Revenue.
MAJOR AREAS OF RESPONSIBILITY:
- Abstracts and validates information such as principal and secondary diagnoses and procedures. Utilizing CPT, and ICD-10 CM coding books and assigns proper codes to medical services or charges.
- Perform charge reconciliations to ensure all charges are being captured.
- Maintains updated knowledge of coding requirements; including continuing education and certification renewal.
- Review and performs necessary coding and billing corrections for all insurance coding and medical necessity denials.
- Assists the billing staff with coding questions.
- Consistently meets the department specific requirements for quantity standards.
- Consistently codes 95% accuracy rate or better for quality standards.
- Review billing reports; ensure timeliness and accuracy of all claim submissions and billing procedures.
- Prepare and submit clean claims to various insurance companies to include both paper and electronic.
- Extensive insurance follow-up and working knowledge of the appeals resolution process is required.
- Responsible for contacting insurance companies and navigating insurance websites in order to secure and expedite payments.
- Post insurance payments in a timely and accurate manner.
- Answer billing inquiries from patients, clerical staff and insurance companies.
- Identify and resolve patient billing complaints.
- Prepare, review, and send patient statements for Medical Center.
- Reconcile daily receivables for the Medical Center.
- Evaluate patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.
- Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers.
- Participate in educational activities and attends monthly staff meetings.
- Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Perform other duties for Medical Center.
KNOWLEDGE, SKILLS, ABILITIES AND OTHER QUALIFICATIONS:
- High school diploma
- Certified Professional Coding (CPC) certificate, with at least 2 years of coding experience.
- Federally Qualified Health Center (FQHC) billing experience preferred.
- Three to five years of medical billing experience in a medical office setting or equivalent combination of training and experience required.
- Must have strong knowledge of CPT and ICD-10 codes and basic medical terminology skills.
- Experience with EMR (Electronic Medical Record) and medical billing software preferred. (Epic experience is preferred).
- Knowledge of third-party operating procedures and practices, with the ability to read and process EOB’s.
- Proven track record of exceeding goals; evidence of the ability to consistently make good decisions through a combination of analysis, experience and judgment; abilities in problem solving, project management and creative resourcefulness.
- Must be proficient in use of Microsoft Office (Access, Excel, Word and Outlook).
- Ability to work in a fast-paced, deadline-driven, changing environment.
- Manages multiple demands, work well under pressure and work independently.
- Highly organized multi-tasker who sets individual and team priorities and effectively monitors progress towards achievement.
- Must possess sound business judgment, exercise professional conduct, understand and follow business ethics and standards, and maintain a high level of confidentiality in all duties.
- Must possess outstanding verbal and written communication skills along with strong interpersonal and organizational abilities.
- Ability to function effectively as a member of a team, and a willingness to participate in activities and assignments that will benefit other members of the team or will contribute to the accomplishment of team objectives.
- Must be able to establish and maintain professional, productive and courteous interactions with employees that promote positive teamwork, as well as with constituents of the organization. This encompasses going beyond giving and receiving instructions and includes but is not limited to (a) performing work activities requiring interacting or speaking with others, and (b) responding appropriately to constructive feedback or suggestions for improvement from a supervisor.
- Must have sensitivity to, interest in and competence in cultural differences, HIV/AIDS, minority health, sexual practices, and a demonstrated competence in working with persons of color, and gay/lesbian/bisexual/transgender community.
- Professional appearance and demeanor.
Background and reference checks will be conducted. Hours may vary, including working some evenings and weekends based on workload. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment. In accordance with Equitas Health’s Drug-Free Workplace Policy, pre-employment drug testing will be administered. EOE/AA
It is the policy of Equitas Health that no employee or applicant will be discriminated against because of race, color, religion, creed, national origin, gender, gender-identity and expression, sexual orientation, age, disability, HIV status, genetic information, political affiliation, marital status, union activity, military, veteran, and economic status, or any other characteristic protected in accordance with applicable federal, state, and local laws. This policy applies to all phases of its personnel activity including recruitment, hiring, placement, upgrading, training, promotion, transfer, separation, recall, compensation, benefits, education, recreation, and all other conditions or privileges of employment.
Equitas Health values diversity and welcomes applicants from a broad array of backgrounds.