GENERAL DESCRIPTION OF POSITION:

This position is vital in the health care delivery system in function with the fiscal aspect of the Clinic. Adhere to policies and procedures in conducting all clinical charges, payments, adjustments for proper billing and collections. Bills and submits claims to insurances/programs, follows up on claims statuses, resolves claim denials, submits appeals, post payments and adjustments, and manages collections. Great customer service and telephone etiquette, computer knowledge, professional appearance, attention to detail, able to multitask and work in a fast paced environment. Ability to work well under stress and maintain calm under pressure and work well with team members and willingness to cross-train. Functions as a member of a collaborative health care team to create and maintain a patient centered medical home.

ESSENTIAL JOB FUNCTIONS: (with or without accommodations)

Communication: Communicates with outside providers offices and insurance/program representatives by telephone in a pleasant, culturally and linguistic manner or by secure email. Assure all questions are answered or resolved in a positive and cordial manner regarding billing issues and/or collection of fees for timely billing. Communicates unresolved issues to the supervisor or designee as needed.

Primary Billing Functions: Reviews and analysis patient’s medical records for accuracy in correct diagnosis and CPTs, HCPCs codes for billing. Bills and codes as per policies and procedures of each specific program/grant and/or insurance.

Accurately enters daily office and/or hospital charges into our database using medical coding protocol to produce a statement or a claim for payment. Reviews medical records and efficiently addresses any discrepancies in coding with the medical provider. Verifies insurances when needed. Performs root cause analysis and identifies trends timely to minimize lag delays and maximize opportunities to improve processes. Enters payments received on accounts, applies payment to existing charges and ensures account balances are current and correct to include third party payers. Productivity measures must be maintained at all times to ensure insurance, program/grants deadlines are not missed and all revenue is captured

Traveling to different clinics when needed to train or gather information for proper billing.

Secondary Collections Functions: Submits claims daily to carriers via electronic batches, reconciles batches per system protocols. Responsible for accurate and timely resolution of preparing professional billing claims and working clearing house edits; obtaining referral information and authorizations for encounters as required by payers. Responsible for working daily on rejections and denials and ensuring billing deadlines are not missed. Identifies and documents new payer denial trends and notifies supervisor. Follows up and thoroughly researches reason for denied/rejected claims and works appeals as necessary to resolve outstanding balances. Ensures appeal deadline with payers are not missed. Downloads electronic and reviews EOB’s and correct errors promptly. Posts insurance payments accurately against patients accounts and reconcile charges on a daily basis. Works all correspondence received, including zero payments, denials and other information received from insurance carriers on a daily basis. Assists in providing copies of medical records including billing records in a HIPAA compliant manner. Receives calls from outsides offices and assists questions regarding payments, EOB’s and reasons for denials as requested by the patient at the office. Other duties as assigned

Team Communication: works closely with physicians, and other departments to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues and AR payments or denials. Educates staff on insurance policies to minimize denials/rejections as needed.

Management of Documentation: Assures all billing and collection documentation is accurate and current. Documents all adjustments and or refunds as needed. Assures all appropriate documentation required for our clinic programs is accurately captured. Documents all adjustments and or refunds as needed.

Demonstrates Safe Professional Conduct: Submits required documentation in a timely manner (credentialing requirements, license renewals, certifications, CNE attendance, etc.). Responsible for their own safety as well as the safety of others.Must always adhere to a professional appearance in dress and behavior/conduct.Maintains a friendly environment for self and others. Refrains from texting and speaking on the cell phone. Refrains from informal communication with patients and others. Fully participates in performance improvement and follows all Clinic policies and procedures. Attends work on a regular and predictable schedule in accordance with clinic leave policy and performs other duties assigned. Submits required documentation in a timely manner.

POSITION DIRECTLY SUPERVISED: None

KNOWLEDGE, SKILLS, AND ABILITIES: (use of equipment, job related knowledge, language, etc.)

KNOWLEDGE, SKILLS, AND ABILITIES: (use of equipment, job related knowledge, language, etc.)

Knowledge of PCMH Model

Knowledge of SC policies and procedures

Knowledge of medical billing practices

Knowledge of ICD-10 and CPT coding

Knowledge of computer software (Microsoft Word, Excel, Outlook etc.)

Skilled in customer relations

Skilled in the use of a computer

Skilled to examine documents for accuracy and completeness

Skilled in billing and coding

Ability to provide effective customer service on a daily basis

Ability of read, write and spell correctly

Ability to maintain and effective and professional working relationship with the public and co-workers

Ability to bend, stretch, stoop, stand, sit and lift up to 20 lbs

Ability to operate a keyboard, telephone, and other office equipment

Ability to examine documents for accuracy and completeness

Ability to prepare records in accordance to detailed instructions

Ability to communicate fluently in English and Spanish

Ability to maintain a positive work environment

Ability to work in a fast paced environment

Ability to maintain a flexible work schedule

Ability to maintain client and office confidentiality

Ability to fully comply with the enhanced infection control requirements of the clinic.

MINIMUM QUALIFICATIONS/CERTIFICATES/LICENSES/REGISTRATIONS REQUIRED:High school diploma or GED; and certification in Billing and Coding from an accredited program or two years’ experience as a medical biller/coder.

SPECIAL INSTRUCTIONS: This position requires handling cash, collections, payments, billing, purchasing or inventory duties and as such will require taking no less than five (5) consecutive days of accrued annual leave days per year. Therefore, five of the accrued annual leave days will be reserved for this purpose.

This position requires travel. Employee must provide transportation. If employee operates a personal motor vehicle in the performance of their official duties, the employee must possess a current valid Texas driver’s license for the appropriate type of vehicle and Texas Liability insurance.

Due to the nature of SC Services, it may be necessary for employees to work extended hours or other variations of the usual shift to ensure adequate care to patients, maintain service to the community and meet third party department needs.