Medical Biller - Credentialing

Summary: Responsible for providing direct support to the third party Billing Agency and the clinical teams. Performs the duties of a claims analyst; focusing on verification, authorization, billing, claims submission and resubmission for recovery of all services provided in order to maximize reimbursements. Duties and Responsibilities include the following.

• Serve as the primary contact between the billing agency and the clinical staff.
• Responsible for granting access, maintaining accounts, and training on use of all Web Portals for all front desk staff at all sites.
• Retrieve the electronic EOBs and remit details from the various payer web sites and forward relevant information to the Accounting Department and the third party Billing Agency utilizing multiple electronic communications methods.
• Responsible for maintaining departmental files in an organized manner which allows for the rapid recovery of data upon demand.
• Sustain an annual file archiving process which will enhance the organization of all maintained files.
• Perform regular updates of the Practice Management System spreadsheet (PMS) for accuracy and completeness. Provide necessary support to the Accounting Department during the month end PMS reconciliation to the accounting software.
• Monitor and maintain all unprocessed and rejected claims from the third party Billing Agency. Analyze claim returns and rejections from the third party Billing Agency to determine the reason for the return/rejection; performing needed corrections as appropriate. Forward information to appropriate clinical/provider staff for prompt correction of returned and rejected claims.
• Develop and maintain document management processes for all incoming correspondence.
• As assigned by the Revenue Cycle Manager, monitor and report on the status of “old” and special category AR accounts such as small balance accounts, credit balance accounts and others.
• Perform periodic audits of the work of the third party Billing Agency and patient charts to ensure all charges are appropriately captured and all claims are appropriately submitted.
• Perform chart audits to ensure all charges are captured and claims submitted as well as to ensure the accurate and complete performance of and appropriate documentation of the patient registration process.
• Pull Insurance Carrier performance reports to ensure that practices are aligned with incentivized programs. Provide recommendations for improvement to the Medical and Operations Directors and the QI team.
• Serve as the Primary Trainer for the MAA role. Training will be given during the new hire orientation process and on an ad hoc basis as needed.
• Serve as a mentor and information resource for the clinical front desk staff by being available by phone and email to answer questions during business hours and by traveling to each clinic site at least once a week to observe and work with front desk on any ongoing training needs, as identified by the Revenue Cycle Manager, Operations management or Finance Department.
• Work with clinical team and provider representatives to capture missed revenue arising from patient care needs.
• Pursue continuing education and/or training on all industry related changes with a direct impact on Advantage Health Centers as well as changes to regulations for governmental healthcare centers.
• All other duties and projects as assigned.

Qualifications:

• High School Diploma and 3-5 years of Front Office (medical office) experience with a demonstrated knowledge of the patient scheduling and registration process. Experience should include knowledge of ICD, HCPC and CPT coding methodologies. Additional knowledge of CMS, Third Party Payers and Managed Care Guidelines is preferred.
• Experience in Success EHS Practice Management System is preferred.
• Must possess the ability to work under pressure and be able to exhibit excellent time management skills; ensuring all deadlines are met.
• Must demonstrate a personal commitment to the organization’s core values through active involvement in the Quality Improvement process.

• Excellent written and verbal communication skills and the ability to present information to groups of 2-5 people from various backgrounds consistently and effectively is required.
• Must possess high level interpersonal skills to interact effectively with clinical staff, providers, patients and other individuals outside of the Advantage Health Centers organization.
• Demonstrated computer, keyboard, internet and clearing house proficiency is required.
• Must be capable of working independently and demonstrate initiative in order to function effectively in a fast paced environment with frequent interruptions.
• A valid drivers’ license and reliable transportation is required.