Billing Representative - Part Time

Summary:

This position is responsible for reviewing provider charges and insurance, making corrections as needed, adding modifiers, and processing provider charges from the Holding Tank, tasking providers with clarifying questions or notification of un-submitted charges, manual entry of hospital and nursing home charges, and providing support to the billing company as needed with A/R follow-up.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Understand functions within the Practice Management system of Nextgen including batch posting, holding tank, charge screen, and work log
• Collect hospital charges from Women’s Care providers on a routine basis in addition to reviewing weekly hospital surgery schedules and daily census in order to ensure timely submission of charges. Download all pertinent information including Patient H&P, Face Sheet, and Discharge info from the hospital’s EMR system, review documentation and using most recent Coding Books assign CPT codes, ICD-10 codes, and modifiers. Enter charges into Nextgen system when the required documentation is available and the patient has been discharged. Utilize provider as a resource for any questions
• Maintain monthly lists of NSTs, Surgeries, and Deliveries
• Coordinate signed consents for Tubal and Hysterectomies with surgery scheduling staff at Women’s Care office
• Reconcile hospital charges monthly; f/u as required
• Follow Up on encounters related to Hospital Services placed in the Work Log
• Collect Nursing Home and Home Visit charges from the Providers; f/u with Providers when the template has not been completed for billing. Look up the ICD-10 diagnosis, manually enter charges in Nextgen, check insurance eligibility and pull over correct insurance(s); process charges, ensure claim has dropped with the correct Revenue Code and MC G Pmt. code; follow up on NH or Home Visit encounters in the Work Log
• Review and Process Dental Charges from the Holding Tank; ensure Dental Hygienist Visits are auto adjusted. Work with each Dentist office to reconcile invoices and then send to the Dir. of Finance for processing. Regularly work the Denial Report and alert leadership of Credentialing, KY Wrap, Timeliness or any other trends that need addressed. Follow up on Dental encounters sent in the Work Log

Review and Process Medical, Behavioral Health, and Telehealth charges from the Holding Tank. Review Insurance, Location, and Provider related information. Review ICD-10 and CPT codes. Add appropriate modifiers, global codes, zero out charges as indicated in Standard Operating Procedure, change Place of Service when needed, and process Sliding Fee out of the charge screen and calculate and calculate/apply Prompt Pay Discounts. Hold processing as needed such as when to perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS:

• Pleasant personality and professional demeanor
• Cooperative attitude-Flexible
• Detail Oriented
• Effective written and oral communication skills
• Highly organized work habits with ability to prioritize
• Intermediate computer skills with Microsoft Word and Excel
  
  

Familiar with Electronic Medical Record

EDUCATION and/or EXPERIENCE:

Must have completed high school. Medical Office experiences a plus.

Must have a minimum of 2 years medical office billing experience.

WORK ENVIRONMENT:

Grace Health is a faith-based, federally qualified community health center (FQHC). We provide primary health services to underserved, underinsured, and uninsured individuals in the southeastern Kentucky region. Our mission is “to show the love and share the truth of Jesus Christ to southeastern Kentucky, thorough access to compassionate, high quality, primary health care for the whole person” regardless of ability to pay.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Credentialing hasn’t been completed or ancillary charges have been submitted but E/M or Preventive CPT have not. Task providers when questions arise during claim processing
• Work Log follow up for claim prod errors, medical records and authorization requests, coding errors, credentialing issues etc. Trends should be identified and shared with appropriate leadership so pertinent information can be shared or changes can be made to reduce future denials
• Process Un-Applied Credits
• Verify Patient Credits and collaborate with Accounts Payable to process
• Appropriate referral/coordination with staff who can make adjustments
• Help answer Customer billing questions as needed and refer questions to Leadership
  
  

OTHER ESSENTIAL DUTIES and RESPONSIBILITIES:

• Grace Health recognizes that managing patient care is a team effort that involves clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
• Team members must demonstrate excellent team communication and coordination to provide quality patient care
• Care coordination includes communicating with community organizations, health plans, facilities, and specialists
• Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by this practice.
• Team members must demonstrate skill and knowledge related to effective communication with vulnerable patient populations
• Team members must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high quality care.
• All team members will be involved in the process of improving quality incomes
• Team members will participate in the review and evaluation processes of practice performance and help to identify opportunities for improvement
  
  

Team members will participate in Grace Health's advocacy program.

GENERAL DUTIES:

• Follows policies and procedures of the office, including administrative, clinical, quality assurance, and personnel
• Maintain good attendance (daily, meetings, and other assignment tasks)
• Maintain timely documentation of all work assignments
• Maintain patient confidentiality
• Routinely keep supervisor informed about attendance and job assignments
• Flexible in being able to multitask
• Work effectively and at an efficient pace
• Work cooperatively with physicians, administration, and peers
  
  

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

SKILLS:

• Pleasant personality and professional demeanor
• Cooperative attitude-Flexible
• Detail Oriented
• Effective written and oral communication skills
• Highly organized work habits with ability to prioritize
• Intermediate computer skills with Microsoft Word and Excel
• Familiar with Electronic Medical Record
  
  

EDUCATION and/or EXPERIENCE:

Must have completed high school. Medical Office experiences a plus.

BENEFITS:

• Safe harbor 401(k) with match potential
• Paid time off
• Family friendly work environment
• Health insurance
• Wellness program
• Health savings account
• Pharmacy benefit
• Employee visits for medical services
• Dental insurance
• Vision insurance
• Life Insurance
• STD/LTD
• EAP & Work life services
• Voluntary benefits
  
  

Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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