Hill Country Health and Wellness Center

Job Description

Job Title: Billing Specialist-Certified Billing Coder
Department: Billing

FLSA Status: Non-Exempt

Reports To: Chief Financial Officer

Hours: Monday – Friday 8:00am – 4:30pm

POSITION SUMMARY:
Position requires a current certification in medical coding. Excellent working knowledge of medical, dental and behavior health coding terminology (ICD-10, CPT, HCPCS). Insurance reimbursement practices as it applies to a Federally Qualified Health Center (FQHC). This includes but is not limited to: Verifying patient eligibility, preparation, and submission of claims, denied and unpaid claim resolution, payment posting, answering billing questions and working on patient collections. This specialist is available to provide medical billing and coding expertise to clinic staff and has excellent knowledge of the practice management system.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• 
  Maintains the practice management system (i.e. system setup, libraries, etc.) with current billing codes and payer/provider setup to ensure proper claim submissions. Creates reports from practice management system as needed.
• Researches and implements, within the facility, any federal or state coding and billing changes. Maintains compliance with federal regulations.
• Supports complete and timely revenue collection from patients, third party payers, via accurate entry and/or correction of patient charges and insurance information into practice management system.
• Reviews and submits clean claims to various payers either electronically or via paper, in a timely manner.
• Creates, reviews, and works to completion on all billing related reports.
• Maintains productivity standards and revenue cycle management standards to ensure all claims are handled properly.
• Obtains accurate information via email, telephone, in person or in writing, by asking the right questions and listening carefully.
• Reviews and works aging of AR on assigned payers/financial classes monthly, so that internal AR goals are met or exceeded.
• Understands and has ability to problem solve complex billing, coding, and reimbursement issues.
• Follows up with payers on open insurance claims.
• Understands contractual relationships with payers.
• Effectively works with external third party (insurance) payer representatives to validate and correct information.
• Reviews accounts and applies billing knowledge required to ensure proper and maximum reimbursement.
• Reviews, understands, and effectively communicates information from Explanation of Benefits (EOB) documents from payers, as well as operating instructions, and procedure manuals.
• Processes and posts payments from payers and patients into practice management system. Assists patients with billing inquiries and consistently displays excellent customer service skills.
• Understands appropriate procedure for refund to patients and insurance agencies.
• Verifies daily electronic claim submissions and edits and corrects claims that are suspended at clearinghouse or directly with payer.
• Meets required deadlines for billing State and Federal programs.
• Files and retrieves all pertinent documentation related to patient accounts.
• Identifies problematic trends and potential solutions, then presents data and recommended action plan to department manager and assists in the training and implementation of finalized plan. Collaborates with other departments to develop and implement solutions, as needed.

QUALIFICATIONS:

Certification as a Professional Coder a must

Knowledge and experience with current ICD-10, CPT, HCPCS coding system

Three or more years’ experience within the billing department at an FQHC preferred

Previous management experience

High school diploma or equivalent

CUSTOMER SERVICE AND LANGUAGE SKILLS:

Must have intermediate language skills. Ability to read and comprehend instructions, correspondence, and memos. Ability to write simple correspondence. Ability to prepare reports. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization using excellent customer service skills.

COMPUTER SKILLS:

This job requires strong computer skills and the ability to learn new software systems and protocols. Requires the ability to navigate various portals for billing information. Candidate should have basic working knowledge of Windows operating systems Microsoft Office Suite - Word, Excel, Outlook and Teams. Will be working in Athena Practice EPM, EMR, EZ print ERA management and other related software.

EQUIPMENT SKILLS:

Must be proficient with computers, printers, 10-key, copiers, fax machines, and multi-line telephone systems.

MATHEMATICAL SKILLS:

Must have intermediate math skills. Ability to perform and complete well a wide range of simple and complex accounts receivable medical/dental billing tasks accurately and consistently. Ability to do basic math and calculate figures and amounts such as discounts, interest, proportions, percentages.

REASONING ABILITY:

Must have high level reasoning skills. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

WORK ENVIRONMENT:

The work environment is an indoor business office environment. The noise level in the work environment is usually moderate with normal business office, computer and printer noise. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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 accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds and on occasion lift and/or move up to 50 pounds with assistance. Employees must regularly utilize close vision, distance vision, and ability to adjust focus.