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DESCRIPTION OF WORK:      

The Billing Representative contributes to IHC’s mission and goals of client satisfaction, quality of care, and productivity by accurately and efficiently processing third party accounts receivable paperwork to ensure timely payment for clinical services.  The Billing Representative works with the billing staff and third party payers to problem solve and ensure compliance with all billing policies and procedures. 

DESIRABLE KNOWLEDGE, SKILLS AND ABILITIES:

Knowledge of policies, procedures, rules and/or laws (i.e. HIPAA) administrative methods, and precedents for medical cost recovery, billing, and accounts receivable management, along with detailed knowledge of the establishment’s operations, structure, procedures, and specialized knowledge. 

Billing and Customer Service:

  • Acts as direct liaison with clinic or practice group in regard to billing and claims.
  • Reviews and corrects claims from locked encounter report daily.  The locked encounter report must be completed daily.
  • Checks claims in ERA denied status and pending with errors weekly.  Sends e-mails to Practice Manager/Office Manager for any needed help in correcting claims.
  • As time allows, check Medicaid Pending claims in assigned sites weekly.
  • Processes client refunds timely and accurately weekly.
  • Helps clients with questions about their balances.  Offers payment agreements that do not extend balances past 6 months.
  • Uses Electronic Health Record reports to work AR.
  • Keeps receivables for each site they are responsible for at corporate goal of 30 days or below.
  • Prepares accounts to send to collections.  Must have accurate and complete documentation accompanying request.
  • Follows all IHC policies and procedures for accurate and timely billing of claims.

Excellent customer service for both internal and external staff/clients/vendors.

Logic and analysis – Able to:

  • Think logically and analytically
  • Demonstrate proficiency in moderately complex mathematics
  • Demonstrate basic problem solving, good judgment, and decision-making skills

Communication – Able to:

  • Demonstrate effective verbal and written communication skills
  • Demonstrate positive customer service skills
  • Work with diverse employees and patients from different backgrounds and education levels
  • Demonstrate understanding appropriate to experience level of record keeping and medical claims billing processes
  • Demonstrate basic knowledge of generally accepted bookkeeping principles
  • Understand billing and reimbursement requirements for FQHCs, Medicaid, Medicare, and private insurance
  • Apply most recent regulations/guidelines for non-profit, health care cost recovery, and billing
  • Knowledge of collections and ability to work with staff, customers, and third party payers to solve problems

Work Product:   Able to:

  • Demonstrate highly detailed, organized, and accurate work
  • Consistently meet deadlines; perform work timely and efficiently
  • Demonstrate knowledge of standard office practices and procedures
  • Participate in high-performing work teams; maintain a team approach to problem solving
  • Prioritize tasks and time and follow up; consistently and completely meet deadline
  • Juggle multiple requests and meet multiple deadlines.

 

Technology –Able to:

Demonstrate computer skills, including typing and alpha and numeric data entry; able to use Microsoft Word, Excel, Outlook, and electronic health records and billing software.

 

EDUCATION AND EXPERIENCE

High school diploma or equivalent.  Medical and dental experience preferred. Two (2) years billing experience for Medicaid/Medicare/Insurance and Dental claims.

 

         

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