First Choice Community Healthcare
Central Billing Representative II
First Choice Community Healthcare, Albuquerque, New Mexico, United States, 87101
Overview
Central Billing Representative II
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First Choice Community Healthcare Location: Albuquerque, NM. Employment type: Full-time. Description
Job Title: Central Billing Representative II Position Code: A15N Non-Exempt Department: Central Billing Position Category (330): Fiscal and Billing Staff (L30b) Position Category (Rphca): Administration Staff The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Position Summary
Under the supervision of the Central Billing Supervisor who reports to the Director of Revenue Cycle Management, the Central Billing Representative II is responsible for all patient accounts receivable functions as assigned. Reconcile, research, correct and submit third party claims and resubmit errors or denied claims. Communicate with insurance companies and government payers to resolve claim issues and ensure payment. Research and correct ICD-10, CPT coding, modifiers, revenue coding, occurrence codes and value codes as appropriate. Provide customer service to patients by researching billing issues and resolving the issues. Reconcile remittance advice and patient accounts and resolve discrepancies. Essential Duties and Responsibilities
Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers. Follow up on claims denials, make appropriate corrections, obtain approvals and resubmit claims denials for payment; appeal denials through the payer required appeals process. Research unpaid claims; contact patients to obtain necessary information to assist with the claims process; secure payments or negotiate payment plans. Handle patient inquiries, complaints and customer service issues. Maintain current knowledge of regulations for Third Party Payers, Medicare, Medicaid and knowledge of claims coding and formats. Coordinate electronic patient statements monthly. Review credit balance reports and prepare refund requests for overpayments. Participate in billing Helpdesk customer support; receive, respond and document all incoming account inquiries related to billing issues. Review assigned outstanding A/R to identify problems with various insurance payers (e.g., Medicare, Medicaid, Commercial, Contracts, Self-Pay). Perform routine and special follow-up on all assigned payer type accounts to collect patient and insurance balances. Review and resolve all EOBs including those without payment to initiate clean claim resubmission and claim reimbursement. Edit & submit insurance claims for fee for service and prospective payment system reimbursement. Follow up with outstanding A/R for all payers including self-pay and resolution of denials. Communicate payment terms and establish agreed-upon payment plans for overdue patients. Monitor payment compliance with terms of established plans with patients and insurance plan provider representatives. Complete bad debt process based on FCCH procedure. Initiate & complete account adjustments to correct account balance and/or comply with contractual and sliding fee scale requirements. Responsible for all other duties as assigned. Requirements
C. Minimum Education and Experience
High school degree or GED; Two years in billing/claims experience in healthcare setting or FCCH billing externship. Education or knowledge may be substituted for the experience requirement. Experience in a multispecialty clinic setting. D. Preferred Licenses/Certifications
Certified Coder (medical and/or dental); Billing Certificate, the result of graduation from a certified billing school; Coder and/or Billing Certificate may be substituted with demonstrated proficient knowledge of CPT & Dental Coding and/or ICD-10 diagnosis coding. E. Knowledge, Skills, and Abilities
General knowledge of computerized practice management systems, preferably Cerner PWPM Practice Management System, Cerner EHR and Dentrix Dental billing and EHR; Ability to learn billing and collection systems within federally chartered CHCs and RHI/UHI programs; Ability to communicate with tact and diplomacy with diverse groups of people including staff, providers, and insurance companies on behalf of the organization; sensitivity to the patient population served; Ability to work on multiple assignments concurrently within established deadlines; Ability to work with others in a team environment; Knowledge of HIPAA related to medical, dental & behavioral health billing; High level of accuracy and attention to detail; Effective written and verbal communication; Ability to respond effectively to sensitive inquiries or complaints; Ability to work independently with minimal supervision; Proficiency with computers and MS Windows; Knowledge of Federally Qualified Health Care billing and reimbursement preferred; Working knowledge of CPT, Dental ADA, DSM V and ICD-10 preferred; Knowledge of Medicare and Medicaid guidelines; Knowledge of UB04, HCFA1500 and Dental ADA Electronic and Paper claim forms; Knowledge and familiarity with compliance programs; cooperate fully with laws and regulations. Physical Characteristics / Working Conditions
Prioritize and respond to diverse demands; mostly office-based in a controlled environment. Physical effort: Good dexterity to operate a computer and office equipment; occasional lifting. Equipment: Capable of using office machines and computers for word processing and data entry. Visual/Hearing/Speaking: Ability to read a computer monitor and clearly communicate for work and compliance. Environment: Office in a controlled environment; travel throughout the Albuquerque metropolitan area; typical schedule Monday-Friday; some weekends/evenings may be required. Seniority level
Entry level Employment type
Full-time Job function
Accounting/Auditing and Finance Industries
Accounting Referrals increase your chances of interviewing at First Choice Community Healthcare by 2x Get notified about new Billing Representative jobs in Albuquerque, NM.
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Central Billing Representative II
at
First Choice Community Healthcare Location: Albuquerque, NM. Employment type: Full-time. Description
Job Title: Central Billing Representative II Position Code: A15N Non-Exempt Department: Central Billing Position Category (330): Fiscal and Billing Staff (L30b) Position Category (Rphca): Administration Staff The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Position Summary
Under the supervision of the Central Billing Supervisor who reports to the Director of Revenue Cycle Management, the Central Billing Representative II is responsible for all patient accounts receivable functions as assigned. Reconcile, research, correct and submit third party claims and resubmit errors or denied claims. Communicate with insurance companies and government payers to resolve claim issues and ensure payment. Research and correct ICD-10, CPT coding, modifiers, revenue coding, occurrence codes and value codes as appropriate. Provide customer service to patients by researching billing issues and resolving the issues. Reconcile remittance advice and patient accounts and resolve discrepancies. Essential Duties and Responsibilities
Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers. Follow up on claims denials, make appropriate corrections, obtain approvals and resubmit claims denials for payment; appeal denials through the payer required appeals process. Research unpaid claims; contact patients to obtain necessary information to assist with the claims process; secure payments or negotiate payment plans. Handle patient inquiries, complaints and customer service issues. Maintain current knowledge of regulations for Third Party Payers, Medicare, Medicaid and knowledge of claims coding and formats. Coordinate electronic patient statements monthly. Review credit balance reports and prepare refund requests for overpayments. Participate in billing Helpdesk customer support; receive, respond and document all incoming account inquiries related to billing issues. Review assigned outstanding A/R to identify problems with various insurance payers (e.g., Medicare, Medicaid, Commercial, Contracts, Self-Pay). Perform routine and special follow-up on all assigned payer type accounts to collect patient and insurance balances. Review and resolve all EOBs including those without payment to initiate clean claim resubmission and claim reimbursement. Edit & submit insurance claims for fee for service and prospective payment system reimbursement. Follow up with outstanding A/R for all payers including self-pay and resolution of denials. Communicate payment terms and establish agreed-upon payment plans for overdue patients. Monitor payment compliance with terms of established plans with patients and insurance plan provider representatives. Complete bad debt process based on FCCH procedure. Initiate & complete account adjustments to correct account balance and/or comply with contractual and sliding fee scale requirements. Responsible for all other duties as assigned. Requirements
C. Minimum Education and Experience
High school degree or GED; Two years in billing/claims experience in healthcare setting or FCCH billing externship. Education or knowledge may be substituted for the experience requirement. Experience in a multispecialty clinic setting. D. Preferred Licenses/Certifications
Certified Coder (medical and/or dental); Billing Certificate, the result of graduation from a certified billing school; Coder and/or Billing Certificate may be substituted with demonstrated proficient knowledge of CPT & Dental Coding and/or ICD-10 diagnosis coding. E. Knowledge, Skills, and Abilities
General knowledge of computerized practice management systems, preferably Cerner PWPM Practice Management System, Cerner EHR and Dentrix Dental billing and EHR; Ability to learn billing and collection systems within federally chartered CHCs and RHI/UHI programs; Ability to communicate with tact and diplomacy with diverse groups of people including staff, providers, and insurance companies on behalf of the organization; sensitivity to the patient population served; Ability to work on multiple assignments concurrently within established deadlines; Ability to work with others in a team environment; Knowledge of HIPAA related to medical, dental & behavioral health billing; High level of accuracy and attention to detail; Effective written and verbal communication; Ability to respond effectively to sensitive inquiries or complaints; Ability to work independently with minimal supervision; Proficiency with computers and MS Windows; Knowledge of Federally Qualified Health Care billing and reimbursement preferred; Working knowledge of CPT, Dental ADA, DSM V and ICD-10 preferred; Knowledge of Medicare and Medicaid guidelines; Knowledge of UB04, HCFA1500 and Dental ADA Electronic and Paper claim forms; Knowledge and familiarity with compliance programs; cooperate fully with laws and regulations. Physical Characteristics / Working Conditions
Prioritize and respond to diverse demands; mostly office-based in a controlled environment. Physical effort: Good dexterity to operate a computer and office equipment; occasional lifting. Equipment: Capable of using office machines and computers for word processing and data entry. Visual/Hearing/Speaking: Ability to read a computer monitor and clearly communicate for work and compliance. Environment: Office in a controlled environment; travel throughout the Albuquerque metropolitan area; typical schedule Monday-Friday; some weekends/evenings may be required. Seniority level
Entry level Employment type
Full-time Job function
Accounting/Auditing and Finance Industries
Accounting Referrals increase your chances of interviewing at First Choice Community Healthcare by 2x Get notified about new Billing Representative jobs in Albuquerque, NM.
#J-18808-Ljbffr