What are the responsibilities and job description for the Medical Billing Specialist position at JCHCC DBA Inclusivcare?
GENERAL SUMMARY OF DUTIES: Provides patient account and reimbursement services for all units of the agency that require third party and other billing-related functions (except for grants and contracts).
SUPERVISION EXERCISED: None
ESSENTIAL FUNCTIONS:
- Review documentation for services submitted by Providers to ensure compliance with Billing Guidelines for all Third-Party insurance payers. This includes guidelines for Governmental Payers (Medicaid, Medicare), as well as Private insurance (PPO and HMO) products. Must be adaptable to Service Line expansions to ensure reimbursement requirements are met.
- Responsible for communicating with insurance companies, or other related entities regarding claim rejections.
- In conjunction with the Revenue Cycle Manager, prepares reports specific to Providers which indicate repetitive rejections that are preventable.
- Duties will include but are not limited to the following: processing corrective claims related to denials, authorizations, and verification of insurance. Interaction with Patients regarding billing account issues is also required.
- Responsible for reporting billing related issues to the Revenue Cycle Manager.
- Other job duties as assigned by the Revenue Cycle Manager.
- Ensures compliance with HIPAA and other relevant regulations concerning patient financial information.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION/EXPERIENCE: Certificate or diploma in Insurance Billing and Coding from an accredited institution; or a minimum of five (5) years direct ambulatory or community health billing related experience required. Ongoing Training specific to FQHC Coding and Billing processes required on an annual basis for job retention.
KNOWLEDGE: Understanding of International Classification of Diseases (ICD-10), and Current Procedural terminology (CPT) tools used to submit claims to Third Party payers is needed. A knowledge of computers and proficient software (i.e. Excel, Word, etc.) and internet use is required.
LANGUAGE SKILLS: Ability to read, analyze and interpret Medical Billing Guidelines. This includes general business periodicals, professional journals, technical procedures and governmental regulations.
MATHEMATICAL SKILLS: Ability to work with mathematical concepts such as probability and statistical inference. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical solutions.
REASONING ABILITY: Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
CERTIFICATES, LICENSES, REGISTRATIONS: Certification as a biller required. Coding Certification is a plus.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions, with proper medical documentation/clearance, if applicable.
WORK ENVIORNMENT: 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. The noise level in the work environment is usually moderate.