POSITION LOCATED AT LAGUNA HEALTHCARE COPORATE OFFICES LOCATED AT:

2929 Coors Blvd NW, Suite 306, Albuquerque, NM 87120

POSITION SUMMARY 

Under general supervision of the Revenue Cycle Manager, process payments from insurance companies and third-party payors. Maintain appropriate accounting of clinic encounters by reviewing, analyzing, abstracting and compiling data and statistics. Review, audit and correct errors; assist with the reconciliation of timely submittal of bills to third party payers. Review accounts receivable, post payments and identify and correct denials. Audit billing, correct and re-submit bills to payers to collect for all services rendered. Responsible for ensuring compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. 

ESSENTIAL FUNCTIONS

1. Perform timely analysis of payments or denials to determine appropriate accounting of billing submitted to Medicaid, Medicare and third-party payors/insurance companies.

2. Ensure batched payments are posted and/or adjusted within 72 hours of receipt. 

3. Reconcile all payments and accounts receivable, checking for accuracy and compliance with contract discounts. Follow up on unpaid claims within standard billing cycle timeframe. Research and appeal denied claims. Follow up with insurance companies regarding any discrepancy in payments.

4. Contact third party payers to initiate adjustment if payment or denial is incorrect. Make necessary adjustments to patient accounts utilizing standard adjustment codes ensuring supporting documentation is on file for all account adjustments to document legitimate reason for the adjustment. 

5. Continuously monitor aging patient accounts to ensure unpaid claims are properly paid or adjudicated timely. 

6. Work closely with medical coder and third-party billing staff to ensure all claims are submitted with correct diagnosis and current ICD, CPT and HCPCS Codes.

7. Verify eligibility and benefits for treatments and procedures working closely with Patient Registration Staff to ensure insurance information entered is accurate and up to date to prevent claim denials. 

8. Create and submit all accounts receivable and other reports to Revenue Cycle Manager at the end of every month in preparation for month end reporting. 

9. Retrieve information from electronic health records to identify patient visits and encounters and review medical records to ensure payment is received for all services rendered by LCHC. Evaluate records for internal consistency, completeness, accuracy for payments received. 

10. Identify medical documentation issues and resolve with appropriate staff members and providers without infringing on decisions concerning clinical judgment. 

11. Perform audits and medical reviews by running error listings and/or other data reports to ensure documentation and accountability of all data. Document and report on findings to supervisor and/or Compliance Manager. 

12. Answer all patient or insurance telephone inquiries. Set up patient payment plans and work collection accounts. 

13. Develop and maintain accounts receivable spreadsheets and run collection reports. 

14. Perform quality assurance/performance functions for the department to ensure quality of services are provided. 

15. Create and maintain records and logs which reflect accountability for all coding, billing and accounts receivable claims processed. 

16. Maintain the integrity of patient information; including but not limited to, protecting from any unauthorized disclosures, breaches, or altering/destroying of patient information. Report any security breaches or potential breaches to the immediate supervisor. 

17. Keep abreast of the latest and new concepts and techniques in coding and billing regulations. 

18. Participate in the development of, accreditation, quality and other programs identified to improve patient care.

MINIMUM QUALIFICATIONS

Associate Degree or Certificate in Accounting or Business Administration or High School Diploma or GED with one (1) year of accounting/bookkeeping and/or billing/coding experience. RPMS and IHS electronic health record experience preferred. Accounting or Bookkeeping Certification preferred.

KNOWLEDGE, SKILLS AND ABILITIES

1. Knowledge of Health information Management Systems including theory, principles, practices, techniques, concepts and policies. 

2. Knowledge of RPMS and Electronic Health Record or other similar systems. 

3. Knowledge of International classification of Disease systems and reference such as the ICD 10-CM, ICD-10-PCS, Diagnosis Related Group (DRG), Physician Desk Reference (PDR), Current Procedural Terminology (CPT), HCPCS, Diagnostic and Statistical Manual of Mental Disorders (DSM-V), use of an encoder, and other coding references. 

4. Knowledge of medical terminology. 

5. Knowledge and adherence to the Privacy Act, HIPAA and HITECH regulations. 

6. Ability to work independently with minimal supervision. 

7. Skill in the compilation, analysis, collection, calculation and tabulation of data to summarize and organize for reporting and presentation. 

8. Skill in computerized data entry and information processing systems. 

9. Ability to adhere to all professional and ethical behavior standards of the profession as well policies, federal, state and tribal laws applicable to work duties. 

10. Ability and skill in communicating information both written and verbally using a professional business format. Correct business English, including spelling, grammar and punctuation. 

11. Ability to follow verbal and written instructions. 

12. Ability to promote a positive working relationships with others and to work in a team setting; be diplomatic; be polite & courteous; and use tact in dealing with others. 

13. Principles and practices of medical records, laws, codes and regulations. 

14. Customer service techniques for dealing with a variety of individuals from various socioeconomic, ethnic and cultural backgrounds, in person and over the telephone. 

15. Reading and explaining rules, policies and procedures. 

16. Knowledge of Microsoft Office Suite; Windows Explorer (electronic file handling), Microsoft Word; Microsoft Excel; internet software; and electronic database health records systems.

17. Basic operation of a workstation (turning on/off, knowledge of basic functions and components). Use/storage/maintenance of multiple usernames and passwords. 

18. Ability to give full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

This position may be subject to a criminal history background check, a suitability background check and/or a Fair Credit Reporting Act (FCRA) check. In addition, some positions are subject to a more extensive background check to ensure compliance with Public Law 101-630 Indian Child Protection and Family Violence Prevention Act. Candidates must be able to successfully pass all required background checks to qualify for this position. A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers is also required. All applicants must successfully pass a pre-employment drug/alcohol screening prior to beginning employment and will be subject to random drug/alcohol testing.