Position Summary: Under the direction of the Business Office Supervisor, bills and files paper claims on both UBs and 1500 forms. References DDE for verification of beneficiary’s name for Medicare claims. Identifies and communicates reoccurring billing errors to clinics and business office leaders and recommends solutions or resolutions. Adjusts claims as necessary. Performs Commercial and Medicare billing and research within timeframe and benchmark expectations set by RCM. Utilizes top customer service skills with all customers: clinic staff, patients, government agencies, commercial insurances, Hospitals, physicians and outside vendors.
The following are essential job accountabilities:
- Review daily clinic charges for accuracy. Verify patient account/type and demographic data is accurate and perform corrections as needed to achieve clean submission. File down corresponding fee ticket images uploaded by clinic from previous day’s charge entry.
- Coordinate with office managers and OMNI staff to maintain expected daily submission benchmarks for AR collections, closed claims, clean (first pass rate 90%) and bad debt rates. Update spreadsheet with daily statistics.
- Coordinate with accounts receivable staff regarding denial management corrective actions.
- Review and escalate credit balances to the next step (refund, apply, etc.). Maintain billing file/records by batch in accordance with the established protocol.
- Assist Coordinator of electronic claims in reviewing and correcting DSG rejections. Communicate regularly with Health Center Mangaers and Health Center Nurses to ensure that all billing slips are completed and submitted timely.
- Assist with the training of front office personnel on billing tasks; posting activities, recall accounts and making arrangements on paitent accounts.
- Various other work-related duties as assigned by supervisor. These duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
- HIPAA compliance – Responsible for enforcing compliance with all HIPAA regulations and requirements. Treats all member information confidential.
- Compliance – Ensure compliance with all local, state, and federal regulations.
- QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- IT – Required to learn and use the Electronic Health Record and Practice Electronic System and its components as required by the job functions and highlighted in the Policies and Procedures.
- All employees will participate in Patient Centered Home Health Model at Omni Family Health.
Qualifications, Education, and Experience
- High school diploma or GED
- Minimum of one year billing and accounts receivable experience in a physician practice environment.
- Proficiency and accuracy with multiple office tools and software.
- Accurate data entry skills with the ability to input data into computer systems, compile statistics, and generate reports.
- Ability to work under pressure.
- Ability to demonstrate effective communication skills with providers and management staff.
- Ability to draft and implement collection letters.
- Proficient with excel and other Microsoft office products.
- Knowledge of payor contracts.
Responsible to: Billing Supervisor
Classification: Full-time or Part-time, Non-exempt