Billing Analyst

SUMMARY:

The Billing Analyst will perform manual and electronic billing to all third party insurance companies and patient statements using computerized patient management billing software. This position is responsible for acquiring information for claims processing, posting and processing all payments and EOB denials. To assure timely reimbursement to the Clinic and manage the accounts receivable, the Specialist will review and research past due accounts, follow-up on unpaid claims and re-bill if necessary, and make collection calls on unpaid accounts. The primary purpose of this position is to assume ownership and control of the patient’s accounts receivable. They will be responsible to know and understand the details of what accounts receivable consists of and prepare monthly reports for analysis being able to explain increases, decreases, and trends. Communication with patients and assisting with front office duties may be required occasionally.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Responsible for all third party and patient statement billing and monitoring using computerized billing software on a daily basis.

2. Ensure that all claims have all of the required documentation attached before sending out to payors.

3. Scrub claims, push out claims, work denials and post payments for all clinical visits.

4. Process all EOB payments and denials.

5. Close charges and charts within 90 days/timely filing.

6. Using the computerized billing software as a tool, follow up on unpaid claims and patient accounts and perform necessary research and functions towards collection.

7. Assume ownership and control of the accounts receivable.

8. Understand the details of what accounts receivable consists of (Medicare/Medicaid, private insurance, self-pay, etc.).

9. Prepare monthly accounts receivable reports for Board of Directors meetings and be able to explain increases, decreases, and trends to the CFO.

10. Recipient of insurance company and patient inquiries regarding statement and billing questions.

11. Maintain a filing system for all billing related documents to ensure efficient retrieval.

12. Maintain a billing department desk manual.

13. Assist in front office duties that relate to billing as needed.

14. Consult with patient to assistance with billing needs and questions

15. Maintain positive working relationship with all staff in all departments.

16. Other duties as assigned, which include, but are not limited to, participating in all FQHC Billing Roundtables, Participate in Athena calls, Post CareNet payments and adjustments, Prepare BCCP billing forms and help prepare required documentation for the wrap around invoices quarterly.

SUPERVISORY RESPONSIBILITIES:

Received: Works under supervision of CFO. Supervision is received through personal conferences, general observation of work in progress and periodic review by supervisor of completed work.

Exercised: This position typically supervises no others.

QUALIFICATIONS:

To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Certified Professional Coding certification training may be required within two years of hire and will be provided at the expense of the Center.

Must clear a Level 2 Background Check.

Current (annual) TB screening and Hepatitis B immunization is requested of all employees.

EDUCATION and/or EXPERIENCE:

Graduation from high school or the equivalent. Accounting or Bookkeeping education preferred. Two years of appropriate office work experience, including at least six months performing duties similar to most of those specified above. Experience working with and managing accounts receivable and doing reconciliation’s preferred.

Substitution: Satisfactory completion of an appropriate vocational training course of study such as medical office training may be substituted for up to one year of the required two years of office work experience.

KNOWLEDGE AND ABILITIES:

Knowledge of standard office policies and procedures. Skill in organizing time and managing multiple demands.

Skill in dealing with patients and visitors as well as other staff members.

Knowledge of traditional health insurance plans, Medicare, and workers’ compensation.

Understanding of concept of maximum reimbursement. Knowledge of CPT and ICD coding principles. Understanding of EOB’s and skills in deciphering. Accuracy with data entry and 10-key skills. Understanding of accounts receivable management. Understanding of aging reports.

Understanding of how to do reconciliation.

Ability to research and take necessary action to collect on unpaid claims and patient accounts.

Skillful in the use of calculators, computers, spreadsheet software, and patient management software.

Ability to work independently and use good judgment in work prioritization

Ability to complete difficult/complex tasks. Ability to follow oral and written instructions.

PHYSICAL DEMANDS:

The work environment characteristics 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 required to sit for long periods of time, talk, hear, write, operate a keyboard, visual acuity to read small print and view a computer monitor, reach to the top of a five drawer filing cabinet and lift boxes of no more than 30 lbs.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

All Neighborhood Medical Center facilities are smoke-free environments.

EMPLOYMENT PRACTICES:

Neighborhood Medical Center is an Equal Opportunity institution and does not discriminate against any person in employment or in admission, treatment, or participation in its programs and benefits on the basis of race, color, national origin, creed, and ability to speak English, disability, sex, age or marital status. Persons alleging unequal treatment should contact the Chief Executive Officer.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• Medical Billing & Coding: 1 year (Preferred)

Language:

• Spanish (Preferred)

License/Certification:

• Certification in Coding and Billing (Preferred)

Work Location: One location