Responsible for managing A/R, third party denied claims and secondary insurance claim processing. Ensures that all denied medical claims are corrected and resubmitted for payment within 72 hours after denial is received in order to meet FHCB net collection rate goal of 95%. Performs posting of payments received from insurance carriers via lockbox, EDI and patient payments into the Practice Management System with an error rate no greater than 1%. Communicates with Director, RCM and/or Billing Supervisor on a daily basis and provides internal solutions to the various billing challenges that exist with FHCB staffs, patients and insurance carriers. Performs all duties as assigned by the Director, RCM, Billing & Collections Supervisor or Chief Financial Officer in a timely manner to meet deadlines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Prepare and submit clean claims to various insurance companies either electronically or by paper.
- Monitors and works all insurance balances that fall over 31 days old, ensuring all accounts are processed within timely filing limits.
- Posts payments and reconciles all receipts to patient accounts daily. Reviews account postings to ensure all payments and adjustments are properly posted to patient accounts on a daily basis. Ensure total payments posted to PMS agrees with payment totals per remittance advice from insurance carriers and patients. Ensure that payment denials are properly posted in PMS to allow for subsequent reporting to management.
- Performs daily closes and reconciliation of journals.
- Responds to patient billing questions within 48 hours and advises patient of financial responsibility and or collects valid insurance/demographic information to rebill previously denied claims.
- Update insurance and other patient information in PMS as it become available to you. Add notes to patient account for items requiring follow up and information to next staff user.
- Identifies patient balances that are over 60 days old for further collection efforts including submitting account to a collection agency and/or submitting recommendation for write-offs.
- Reviews the daily EDI claim reports and works the denied claims on a daily basis.
- Monitors monthly aging reports to ensure that claims over 60 days old do not exceed 10% of FHCB’s total payer balance and limiting FHCB’s bad debt expense for insurance claims to 5% of gross charges.
- Establish professional relationships along with contact information with provider representatives for all insurance carriers you represent.
- Maintains strictest confidentiality and complies with HIPAA regulations and FHCB policies and procedures.
- Maintains billing reports and summaries of all billings to support claims. Files all remittance in accordance with Manager’s directives after signing and dating document evidencing completion; ensure that it can be readily retrieved when needed for review.
- Consults with Manager or supervisor daily if needed to address any issues that would deviate from protocols for entering data in the PMS.
- Participates in continuing educational activities relative to assigned duties and responsibilities.
- Adheres to FHCB Code of Conduct as it relates to all employees.
- Consistently follows FHCB policies with regard to time and attendance.
- Performs other duties as assigned by the Director, RCM, Billing and Collections Supervisor and Chief Financial Officer.
- Knowledge of “best practices” of effective management over the provider revenue cycle.
- Knowledge of CPT, ICD-9, ICD-10 and ADA coding and terminology.
- Knowledge of 3rd party billing policies, procedures and practices.
- Knowledge of Medicare and Medicaid regulations regarding billing for services.
- Knowledge of CDT coding and terminology.
- Knowledge of payment posting, efficient in reading and comprehending EOBs and NOPs.
- Skilled with using computerized practice management billing systems.
- Skilled with using Microsoft Office applications.
- Skilled with using a 10 key calculator.
- Skilled with applying knowledge noted above to day to day work responsibilities.
- Ability to understand and interpret corporate and departmental policies and regulations.
- Ability to prepare documents in response to patient complaints and inquiries.
- Ability to examine documents for accuracy and completeness.
- Ability to communicate effectively both verbally and in writing and, works as a team player with others.
- Ability to identify inefficient procedures and recommend improvements for implementation.
- Ability to maintain a professional attitude and office decorum in the workplace.
EDUCATION: High school diploma or GED is required. Medical Billing Certification from an accredited trade school is preferable. Certified Professional Coder a PLUS. Proficiency working with Microsoft Office software is also required.
EXPERIENCE: Minimum of 2-5 years of medical billing experience in a health care provider organization is required. Experience with being a team player to accomplish a common goal will be necessary.
Normal office environment.
Requires sitting and standing associated with a normal office environment. Manual dexterity using a calculator and computer keyboard.
This job description provides a summary of the major duties and responsibilities performed by individuals in this position. Knowledge, skills, abilities, and working conditions may change as needs evolve. These additional duties and responsibilities may be assigned as deemed necessary by your supervisor.