Pccwellness
Overview
Be among the first 25 applicants. Job Summary: Responsible for performing revenue cycle functions for all medical and/or dental claims for PCC Community Wellness Center, to ensure accurate, timely claim follow up for aged accounts. The Medical Biller works collaboratively with Providers, Care Coordinators, Operations, and Revenue Cycle leadership to eliminate department bottlenecks and waste while increasing cash flow and promoting revenue growth.
Responsibilities
Continually monitor claim volume and aging. Actively follow up on aged pending claims that require resolution or next action for payment for assigned facilities
Review, resolve and release claims within 2 business days of claim creation date for assigned facilities
Review and resolve 50 claims daily (minimum); 35 claims yielding reimbursement daily for assigned facilities
Resolve state funded claims prior to 180 days outstanding, perform A/R functions on older dates of service with sense of urgency for assigned facilities
Resolve federal funded claims prior to 365 days outstanding, perform A/R functions on older dates of service with sense of urgency for assigned facilities
Resolve commercial funded claims prior to 90 days outstanding, perform A/R functions on older dates of service with a sense of urgency for assigned facilities
Initiates write off requests for claims for timely monthly processing for assigned facilities
Monitor global transaction report to eliminate incorrect claims adjustments, promoting accurate and timely claim submission for reimbursement for assigned facilities
Maintain a DSO of less than 40 days for all assigned facilities
Track EHR third-party billing issues/concerns as they are found to improve billing department bottlenecks and efficiencies using designated tracker
Track and monitor provider and site credentialing discrepancies, update designated tracker as needed
Perform timely contractual transactions to ensure accurate financial reporting
Adherence to all local, state and federal billing guidelines for medical, dental and 340B services provided
Adherence to all local, state, and federal billing guidelines for behavioral health and telemedicine services provided
Collaborate with PCR site staff to promote patient data accuracy, maintaining a minimum clean claim submission rate of 95% month over month
Collaborate with department peers communicating trends and billing errors to promote clean claim submissions for timely reimbursement
Accurately submits claim resubmissions through EHR for timely reimbursement; engages EHR for large batch resubmission when supported
Under the guidance of department Certified Coder, ensure maximized reimbursement of rendered services through proper claim coding and physician charting
Partner with Enrollment Specialist for pending Medicaid enrollment cases to ensure timely update of EHR medical profile and claim submission
Coordinate with Operations and Care Coordination Teams to obtain authorizations, consent forms and supporting medical records documents as needed for timely claim processing and maximum reimbursement
Track and report outstanding documentation needs to direct supervisor, during 1:1 weekly meetings
Perform audits on denied/rejected claims to understand and execute actions based on findings
Ensure all informational coding and billed services align with clinical documentation for claim processing
Follow through of internal and external inquiries based on assigned workload, within 24 hours
Work with payors through active portals, telephone, fax and in-person appointments to ensure timely follow through of claim processing needs
Complies with established policies and procedures, objectives, HIPAA, safety and environmental standards
Remain abreast on FQHC/340B/Inpatient and dental industry changes; proactive with notifying billing department leaders of any changes
Effectively train new hires and counterparts as needed
Accomplish projects as a team member or individual as assigned
Possible travel between PCC sites
Additional responsibilities as assigned by Administration
Qualifications Ability to
Pivot and accept change to meet the needs of the department and/or organization
Follow-through, assume responsibility and use good judgment
Communicate effectively and diplomatically with patients, external insurance and contracting entities and facility personnel both orally and in writing
Ability to understand and follow verbal and written communication
Experience/Training
2+ years experience in revenue cycle with strong focus on CMS 1500 insurance claims and accounts receivable management required
Athena EHR experience highly preferred
Previous FQHC experience highly preferred
Previous Availity clearinghouse experience preferred
2+ years previous experience with local state Medicaid/Managed Care plans
2+ years pervious experience with commercial payers and EOB interpretation
Technical Knowledge Equipment: PC, email, facsimile machine, computerized voice mail system, and common office equipment
Software Knowledge: Windows, MS Office (Word, Excel, PowerPoint), Medical/Dental Billing Software (Athena)
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
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Responsibilities
Continually monitor claim volume and aging. Actively follow up on aged pending claims that require resolution or next action for payment for assigned facilities
Review, resolve and release claims within 2 business days of claim creation date for assigned facilities
Review and resolve 50 claims daily (minimum); 35 claims yielding reimbursement daily for assigned facilities
Resolve state funded claims prior to 180 days outstanding, perform A/R functions on older dates of service with sense of urgency for assigned facilities
Resolve federal funded claims prior to 365 days outstanding, perform A/R functions on older dates of service with sense of urgency for assigned facilities
Resolve commercial funded claims prior to 90 days outstanding, perform A/R functions on older dates of service with a sense of urgency for assigned facilities
Initiates write off requests for claims for timely monthly processing for assigned facilities
Monitor global transaction report to eliminate incorrect claims adjustments, promoting accurate and timely claim submission for reimbursement for assigned facilities
Maintain a DSO of less than 40 days for all assigned facilities
Track EHR third-party billing issues/concerns as they are found to improve billing department bottlenecks and efficiencies using designated tracker
Track and monitor provider and site credentialing discrepancies, update designated tracker as needed
Perform timely contractual transactions to ensure accurate financial reporting
Adherence to all local, state and federal billing guidelines for medical, dental and 340B services provided
Adherence to all local, state, and federal billing guidelines for behavioral health and telemedicine services provided
Collaborate with PCR site staff to promote patient data accuracy, maintaining a minimum clean claim submission rate of 95% month over month
Collaborate with department peers communicating trends and billing errors to promote clean claim submissions for timely reimbursement
Accurately submits claim resubmissions through EHR for timely reimbursement; engages EHR for large batch resubmission when supported
Under the guidance of department Certified Coder, ensure maximized reimbursement of rendered services through proper claim coding and physician charting
Partner with Enrollment Specialist for pending Medicaid enrollment cases to ensure timely update of EHR medical profile and claim submission
Coordinate with Operations and Care Coordination Teams to obtain authorizations, consent forms and supporting medical records documents as needed for timely claim processing and maximum reimbursement
Track and report outstanding documentation needs to direct supervisor, during 1:1 weekly meetings
Perform audits on denied/rejected claims to understand and execute actions based on findings
Ensure all informational coding and billed services align with clinical documentation for claim processing
Follow through of internal and external inquiries based on assigned workload, within 24 hours
Work with payors through active portals, telephone, fax and in-person appointments to ensure timely follow through of claim processing needs
Complies with established policies and procedures, objectives, HIPAA, safety and environmental standards
Remain abreast on FQHC/340B/Inpatient and dental industry changes; proactive with notifying billing department leaders of any changes
Effectively train new hires and counterparts as needed
Accomplish projects as a team member or individual as assigned
Possible travel between PCC sites
Additional responsibilities as assigned by Administration
Qualifications Ability to
Pivot and accept change to meet the needs of the department and/or organization
Follow-through, assume responsibility and use good judgment
Communicate effectively and diplomatically with patients, external insurance and contracting entities and facility personnel both orally and in writing
Ability to understand and follow verbal and written communication
Experience/Training
2+ years experience in revenue cycle with strong focus on CMS 1500 insurance claims and accounts receivable management required
Athena EHR experience highly preferred
Previous FQHC experience highly preferred
Previous Availity clearinghouse experience preferred
2+ years previous experience with local state Medicaid/Managed Care plans
2+ years pervious experience with commercial payers and EOB interpretation
Technical Knowledge Equipment: PC, email, facsimile machine, computerized voice mail system, and common office equipment
Software Knowledge: Windows, MS Office (Word, Excel, PowerPoint), Medical/Dental Billing Software (Athena)
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at PCC Community Wellness Center by 2x
Get notified about new Biller jobs in
Oak Park, IL .
Chicago, IL $70,000.00-$90,000.00 3 weeks ago
Chicago, IL $72,000.00-$98,000.00 3 weeks ago
Chicago, IL $70,000.00-$95,000.00 1 week ago
Highland Park, IL $18.00-$25.00 1 month ago
Chicago, IL $70,000.00-$82,000.00 1 week ago
Chicago, IL $80,000.00-$90,000.00 2 weeks ago
Chicago, IL $70,000.00-$82,000.00 2 weeks ago
Payment Posting Specialist - Medical Billing Northbrook, IL $52,000.00-$62,000.00 1 day ago
Chicago, IL $46,000.00-$62,000.00 4 months ago
Itasca, IL $60,000.00-$85,000.00 2 days ago
Chicago, IL $48,576.00-$88,000.00 1 month ago
Chicago, IL $70,000.00-$82,000.00 1 week ago
Payment Posting Specialist - Medical Billing
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr