Position Summary:

Responsible for gathering charge information, coding, entering into practice management/billing system (EClinicalWorks (or current system),) gathering and entering payment information, balancing information posted to amounts deposited in bank.

Essential Functions

• Posts charges based upon information from superbills, or as transferred from EMA electronic health record. Assures complete entry of CPT codes, provider, place of service, and all other required fields in EClinicalWorks (eCW, or current system) practice management system
• Posts payments from patients, and insurers, relying upon records from other GSD staff members, (e.g. superbills,) or insurance documentation such as EOBs.
• Imports Electronic Remittance Advice files and auto-posts with eCW,
• Adjusts patient accounts to reflect third party payments and contractual agreements posts adjustments to accounts in EClinicalWorks (or current system) while assuring that payments match contracted amounts.
• Uses clearinghouse services for electronic claim submission and remittance advice. Bills payers for secondary insurance payments in a timely fashion
• Rebills insurers or files inquiries based upon denials, requests for information/documentation or inaccurate payment from insurers
• Monitors Accounts Receivable balances and aging, identifies accounts requiring follow-up. Demonstrates organized efforts to prevent accounts from aging beyond 90 days.

Essential Functions

• Collects outstanding funds through A/R processing, calls to patients, issuing patient statements, and submitting accounts for collection in accordance with GSD standards
• Assures that all daily activities are in balance. Runs reports for billing manager/office manager showing daily and monthly activity. Balances posted payments to bank deposits daily.
• Runs report to identify any outstanding patient superbills daily, and takes steps to locate and process missing tickets
• Reviews GSD charges quarterly and annually to assure charges are adequate to maximize reimbursement. Compares charges to Medicare allowable on a quarterly or annual basis. Makes recommendations for modification to the company chargemaster. (move to lead or billing office supervisor when avail)
• Generates special reports on an as needed basis. Demonstrates a thorough knowledge of the EClinicalWorks (or current system) practice management system and the ability to provide information as requested.
• Corresponds/communicates with patients in response to inquiries related to billing and/or financial planning. Answers telephone and responds to in-person billing inquiries face-to- face.
• Reviews patient superbills or EMA for appropriate diagnostic and procedural coding; secures physician clarification if needed. Reviews potential for improved reimbursement with physician prior to implementing changes.
• Maintains original files of superbills, EOBs, Remittance and other correspondence.
• Monitors payer performance for payment and administrative matters and advises manager/physician of matters requiring attention.
• Identifies accounts representing difficult or unsuccessful collections: recommends accounts for submission to collection agency and/or write-off.
• Generates file for creation of patient statements and submits to statement processing clearinghouse for printing and mailing. Assures accuracy of demographic and patient balance information on statements before submitting.
• Other duties as assigned

Essential Functions

• Demonstrates Knowledge of Job Duties
• Judgment: demonstrates sound forethought and logic in all actions
• Communications: written communications and email are clear and well organized. Checks email throughout the business day.
• Communications: oral communications are clear and appropriate for business Team & Working Relationships: Effective in working with others
• Safety: adheres to all workplace safety standards and policies
• Company Resources: appropriate use of PC, email, rest areas, maintains a clean and organized work environment. Refrains from using company equipment/services for personal matters.
• Attendance: reports for work on-time and as scheduled, available for work as needed Ability to organize and prioritize tasks/responsibilities effectively
• Adheres to all HIPAA standards Maintains strictest confidentiality
• All Golden State Dermatology employees may be temporarily scheduled in any GSD facility based upon the needs of the organization. Employee demonstrates understanding and willingness to go where needed.

Essential Functions

Promotes Golden State Dermatology in an effort to enhance patient comfort and further organization reputation of excellence in the patient, medical, and associated business communities. Conveys a positive image of Golden State Dermatology.

Requirements Knowledge, expertise:

• Proficiency in filing and collecting insurance claims from individual carriers or agencies
• Good customer service skills.
• Working knowledge of all aspects of EClinicalWorks (or current system) practice management system, specific competency in EClinicalWorks (or current system) modules directly related to job duties, e.g. posting charges, payments adjustments, generating reports, using electronic clearinghouse.
• A working knowledge of commercial, Medicare, and HMO insurance industry operating procedures.
• Knowledge of HIPAA standards
• Knowledge of coding.
• Knowledge of word processing and spreadsheet programs.
• Knowledge of compliance, cost reimbursement, and insurance negotiating procedures.
• Ability to maintain confidentiality of sensitive information.
• Ability to process patients and agency inquires.
• Ability to recognize, evaluate, solve problems, and correct errors.
• Ability to establish and maintain effective working relationships with patients and clinic staff
• Skilled in tact and diplomacy in interpersonal interactions
• Skilled in patient education needs by effectively sharing information with patients and families.

Certifications, training, licensure:

• Any of the following:
  • Graduation from accredited Medical Assistant program with an emphasis on medical billing.
  • Proof of high school or GED graduation.
  • Certification from the American Association of Medical Assistants.
  • Demonstrated experience in medical billing and collections.

Safety Requirements:

• Universal precautions
• Safe lifting

Physical Requirements:

• Requires full range of body motion including handling and lifting patients, manual and finger dexterity and eye-hand coordination. Involves standing and walking. Requires normal visual acuity and hearing. Requires exposure to bodily fluids.
• Sitting up to 8 hours per day. Frequent sitting and standing from a sitting position. Use of keyboard and/or computer mouse up to 8-hours per day.
• Ability to use a stepstool, reach overhead. Ability to pull charts from and return charts to medical record storage shelves.

Decision Making Authority:

• Identifies accounts for referral to collection agency and or write-off. Follows established guidelines for writing-off accounts based upon aging and outstanding balance.
• Identifies accounts for follow up with insurers for collection
• Identifies accounts with balances to be transferred to patient responsibility
• Notes accounts with patient balances due and instructions related to permissible patient appointments.