Description

Job Summary: Responsible for all facets of medical billing and accounts receivable management including charge entry, payment posting, customer service and follow-up in accordance with practice protocol with an emphasis on maximizing patient satisfaction and profitability. Responsible for reviewing the patient demographic information in the practice management system at the time of charge entry to ensure accuracy and to provide feedback to the other front office staff regarding patient registration. Responsible for reviewing the physician’s coding at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. 

Primary Job Responsibilities/Tasks:

1. Input all charges related to the assigned physician’s professional services into the practice management system including office and hospital charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction. 
2. Post all payments, by line-item, received for physician’s professional services into the practice management system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability
3. Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines in the Procedure Manual.
4. File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference.
5. Review the physician’s coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement.
6. Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. 
7. Follow-up on all outstanding insurance claims at 60-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.
8. Follow-up on all outstanding patient account balances at 90-days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using the A/R aged reports.
9. Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians, managers and subordinates.
10. Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.
11. Recommend accounts for outside collection when internal collection efforts fail in accordance with practice protocol.
12.  Process refunds to insurance companies and patients in accordance with practice protocol.
13. Reconcile the incoming lockbox deposits in accordance with practice protocol as required to ensure timely payment posting. 
14. Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.
15. Proficiency with all facets of the medical practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.
16. Proficiency with Availity, a web-based program for eligibility verification and claim status, to efficiently conduct accounts receivable follow-up and to maximize revenue.
17. Maintain an organized, efficient and professional work environment.
18. Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance. 
19. Other duties as assigned.

Requirements

Education: High school diploma or GED is required. A college degree is preferred.

Experience: Requires a minimum of 3 years of accounts receivable experience preferably in an Orthopedic setting. 

Other Requirements:

Knowledge:

1. Comprehensive understanding of accounts receivable management in a healthcare setting.
2. Knowledge of managed care plans, insurance carriers, referrals and precertification procedures.
3. Knowledge of CPT, ICD-9, ICD-10, HCPCS, modifiers, coding and documentation guidelines.
4. Knowledge of Medicare Compliance, OSHA and HIPAA.

Skills:

1. Strong customer service, organizational and communication skills are essential to this position.
2. Must demonstrate current competencies applicable to the job position.
3. Requires excellent written and verbal communication skills and strong customer service skills.
4. Requires strong basic mathematical skills.
5. Requires a minimum typing speed of forty (40) words per minute and ten-key by touch.
6. Requires an extensive working knowledge of managed care networks and insurance carriers.
7. Requires an extensive working knowledge of accounts receivable functions including CPT and ICD-9 coding.
8. Requires proficiency in general office automation including operation of fax machines, copy machines, adding machines, postage machines, and multi-line phone systems.
9. Requires proficiency in working with a PC, the Internet, and MS Windows. 
10. Requires a good understanding of the current Medicare Compliance, OSHA, and HIPAA regulations. 
11. Requires a high degree of organization. 

Abilities:

1. Ability to establish/maintain cooperative working relationships with staff and providers.
2. Ability to communicate effectively and in a professional manner with patients using interpersonal skills.
3. Ability to communicate effectively and in a professional manner with all staff, managers and physicians.
4. Ability to prioritize and multi-task.

Physical and Mental Demands:

1. Combination of sitting, standing, bending, light lifting and walking.
2. Requires a full range of body motion including manual and finger dexterity and hand-eye coordination.
3. Requires corrected vision and hearing to a normal range.
4. Requires the ability to manage stressful situations.
5. Occasional stress from varying demands.