MEDICAL BILLING SPECIALST (Community Family Clinic) Idaho Falls

Status: Exempt / Salary        Regular Full Time      Reports to: Clinic Administrator 

Essential Duties and Responsibilities (This is not an exhaustive list of all duties/responsibilities. Other duties may be assigned)

• Verify that claims are submitted with zero errors
• Prepare claims for mailing when necessary
• Timely follow up on insurance claim denials, exceptions or exclusions
• Verify completeness and accuracy of coding prior to submission to Athena
• Monitor and post as needed, payments received from insurance, Medicare, Medicaid, patients, etc. daily to ensure proper credit and accounting
• Utilize monthly aging A/R reports to follow up on unpaid claims aged over 30 days
• Perform A/R audits
• Maintain A/R filing system
• Respond to inquiries from insurance companies, patients and providers regarding coding and billing
• Oversee the operations of the billing department
• Read and interpret insurance Explanation of Benefits (EOB)
• Keep track of P&P patients, create the monthly invoice to submit in a timely manner
• Check Quest Lab monthly invoice for patient payments, if payments not received enter charges
• Timely communication to the Officer Manager regarding trends with payors/front desk and other issues that are potentially disruptive to cash flow
• Review credit balances and act in a timely fashion
• Verify patient statements have been sent out timely
• Ensure aged patient balances, over 90 days, are reviewed and sent to collections as needed
• Follow up with collection agency as needed
• Follow-up on any missing claims/billing
• Collect provider/patient information for appeals
• Run operational/financial and quarterly Medicare reports
• Negotiate and monitor payer contracts
• Oversee refunds and credit balances
• Handle any payment arrangements
• Assist with Provider credentialing
• Work in collaboration with Accounting on pertinent issues affecting revenue
• Review records to ensure proper coding based on guidelines and conventions
• Ability to multi-task, manage time, meet deadlines and remain calm and professional under pressure
• Establish and maintain effective working relationships with staff, patients, organizations, insurances
• Remain current on trends/changes in the laws and regulations governing medical record coding, and documentation
• Maintain standards of confidentiality of CC Idaho clients and records
• Maintain strict confidentiality and compliance with HIPAA standards and other grant requirements
• Perform all work duties and activities in compliance with CC Idaho, Joint Commission, OSHA and HIPAA regulations

Qualifications                                                

Required

• High School Diploma or GED
• One-year experience in medical billing
• Working knowledge of CPT and ICD10 codes and medical terminology
• Current driver's license and proof of auto insurance
• Must pass a background check
• Ability to operate standard office equipment and be proficient in Microsoft Office applications
• Evidence of no communicable disease

Preferred

Certified Professional Coder (CPC) certification