Job Description

This role is responsible for managing the claims and billing processes, including assuring accurate and timely charge entry, timely clean claim creation and billing, aggressive and regular claim status follow-up via electronic and verbal communications. Monitor and handle claim rejections, denials, and denial management via appeals processing. Responsibilities also include individualized specialty focused tasks.

Duties and Responsibilities

• Possess a knowledge of State(s) and Federal billing and reimbursement guidelines, including third party insurance plans as well as changes in policies and procedures, contracts and fee-schedules as designated by the plan and/or the management for the practice.
• Responsible for the day-to-day billing operations, which includes but are not limited to the following:
  • Review professional Fee for Service and Federally Qualified Healthcare Centers (FQHC) claims for charge posting to ensure accuracy and proper coding practices.
  • Prepare and submit clean claims to third party payers either electronically via the assigned clearinghouse or by paper in a timely manner.
  • Payer accepted claim report note: Confirm claims receipt status with payer within seven business days of billing.
  • Work out of the designation work-queues as priority.
    • Identify claims not falling in work queues for reporting to Manager.
  • Responsible for reducing age receivables by aggressive and focused claim management:
    • Claims aged at 45 days and no adjudication status should be escalated to the payer claims adjudication manager.
    • Escalate unpaid claims greater than 60 days of billing the manager for review and determination regarding further collection efforts.
    • Review eob’s within five business day of posting activity for next billing action.
    • Work rejected and denied claims within the department guidelines and standards.
    • Begin and continue bi-weekly claims status review with the payer.
    • Appeal denied claims with aggressive follow-up and resolution.

• Production and distribution of monthly patient statements (when applicable)
• Maintain and follow-up on patient payment plans (when applicable)
• Work with Front Office to ensure appropriate collection of any patient responsibility.

• Retrieval of confirmation reports and verification of claims and statement submission

• Review and evaluation of billing reports for errors and trends, and report issues to Manager.
• Escalate unpaid claim greater than 60 days of billing the manager for review and determination regarding further collection efforts.

Minimum Qualifications

• High School Diploma or equivalent required.
• Associated degree in HealthCare Administration or similar preferred.
• Certification in professional billing (CBC) preferred.
• Minimum of 6 years Healthcare billing and collections required.
• FQHC billing and knowledge preferred.
• eCW knowledge preferred.

Working conditions

This job operates in a remote location from your home location. This role requires a dedicated, quiet workspace with the ability to adhere to HIPPA and other privacy policies. A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment.

Direct reports

None.