Description

DIVISION: Administration/Accounting & Finance

REPORTS TO: Revenue Manager

FLSA STATUS: Non-Exempt

WORK HOURS: Monday through Friday, Various

NATURE OF WORK: This position is responsible for assisting the Revenue Manager in preparing, and submitting medical claims to commercial insurance, government funded plans, grants or other types of payer. This is done through running reports, analyzing data from reports, and looking for inconsistencies in billing by clinical staff in the agency. Basic Knowledge of Microsoft Excel is required, and more advanced knowledge is ideal. The Billing Assistant must possess the interpersonal skills necessary to interact with clients, Valley employees, management, and insurance representatives, to resolve any medical billing question or issue with client account. The Billing Assistant projects a respectful and professional image to clients, the community and fellow employees.

WORK ENVIRONMENT: In-Doors 99%. Outdoors 1% the work environment is a normal office environment.

WORK PACE: Self-paced, requiring the ability to make decisions quickly and accurately in an oftentimes fast paced, demanding work environment.

ESSENTIAL DUTIES:

• Runs reports from multiple sources (Especially in the Electronic Medical Record) and use instructions to find missing data, incorrect data and learn the solution on how to fix it.
• Assists in creating Instruction Manuals for Directors and Supervisors in the Organization
• Uses Electronic Medical Record/Practice Management Software (EMR/PMS) to generate reports to audit/review services and admission setup for any issues that would result in non-clean claim submission or client ledger errors.
• Uses written and/or verbal communication with precise language to inform all necessary parties of any issue with service or client data; including but not all-inclusive, (UM, Admissions, Program Manager, Division Director, Clinical Director, Management Team, and practitioner), which is required for service to be in compliance with clients’ guarantor regulations and billing requirements.
• Tracks and follows-up on verbal or written communication to all necessary parties to confirm billing issue has been addressed prior to claims submission, resubmission or appeal.
• Creates and submits electronic-based services with accuracy
• Uses EMR/PMS and any additional software to create electronic 837 files, paper claims, invoices.
• Uses EMR/PMS, other software, and web portals for submission, resubmission, re-bills, voids, appeals of claims, and checking benefits and eligibility.
• Uses EMR/PMS forms to document all steps taken with claim or client account by documenting activities.
• Transfers EMR/PMS reports to Microsoft Excel and filters, sorts, compares, and creates additional spreadsheets to audit/report and validate client data required for claims submission or accurate client setup.
• Uses EMR/PMS, insurance web portals and explanation of benefits to monitor/audit submitted claims for collection and/or adjudication by insurance within timely filing limits.
• Effectively communicates claim issues to insurance representative, client and fellow employees.
• Effectively uses time management, organization and attention to detail to meet account receivable closing schedule, guarantors timely filing limits, and maintain documentation and reports.
• Accurately analyzes and communicates status of client ledger.
• Professionally resolves issues and answers questions from clients, insurance companies and fellow employees.
• Demonstrates ability to work in a team, as well as individually.
• Monitors all insurance types for regulations or submission requirements changes and communicate those changes to Manager of Billing with information required for practice management setup and Valley HealthCare System to be in compliance.
• Adheres to Valley’s Values and Standards of Performance & Ethical Conduct
• Monitors, maintains and uses appropriately, all equipment and supplies
• Supports and assists in the training of new employees.
• Other Duties as assigned

Qualifications

MINIMUM QUALIFICATIONS:

• Ability to perform essential duties as outlined below
• Valid Driver’s License OR Valid Photo ID Card
• High School Diploma or Equivalent
• Communication & Active Listening skills
• Problem Solving, Attention to Detail, Organization and Multi-Tasking
• Ability to Operate Office Equipment: calculator, fax, copier, and computer
• Basic Understanding of Accounting Procedures
• Intermediate Experience with Microsoft Office Excel; functions and formulas
• Ability to Comply with Consumer’s Rights and confidentiality laws through HIPAA compliance
• Ability to Comply with organization policies and procedures
• Ability to Read, Speak and Write the English language

PREFERRED QUALIFICATIONS:

• Knowledge of Medical Terminology that commonly appears on claims
• Knowledge of Commercial, Medicaid and Medicare Billing requirements and regulations.
• One Year of Recent Experience in Medical Billing
• Experience in Monitoring, Comprehending and Communicating regulations and billing requirements.
• Experience in all types of Claim Submission of Clean Claims to WV Medicaid Fiscal Agent, WV Medicaid Managed Care Organizations, Medicare Part B, and other types of insurance.
• Experience in Submission of clean claims to secondary and tertiary insurance by paper and/or electronic.
• Experience in following-up on claims; paid, resubmission, re-bills, appeals and voids.