Central Billing Representative I

About the role

Under the direct supervision of the Director of Revenue Cycle Management, the Central Billing Representative I is responsible for maintaining a high-performance work environment characterized by positive relationships and a strong orientation towards customer service and timely quality patient billing. This role involves direct interaction and assistance to Site Biller Representatives, patients, physicians, colleagues, contractors, and consultants for the purpose of billing, collection, and reporting of multi-specialty self-pay, third-party payer accounts receivable, and claims on a daily basis.

Responsibilities

• Review site-batched patient encounters for charge and payment accuracy, including encounter rate or other necessary billing adjustments.
• Monitor and review site unbilled encounters and assist when necessary to meet mutual daily and weekly deadlines.
• Provide education on encounter batches to minimize error recurrence and support maximum reimbursement.
• Meet all end-of-month (EOM) closing activities and deadlines.
• Coordinate electronic patient statements on a monthly basis.
• Post payments received and reconcile system postings to lockbox and/or Explanation of Benefits (EOB) totals.
• Record NSF checks returned by the bank and notify patients of adjusted balance due.
• Review credit balance reports and prepare refund requests for overpayments.
• Participate in billing Helpdesk customer support by receiving, responding to, and documenting all incoming account inquiries (electronic, telephone, and written correspondence) related to billing issues.
• Review assigned outstanding accounts receivable (A/R) to identify problems with various insurance payers (e.g., Medicare, Medicaid, Commercial, Contracts, and Self-Pay). Perform routine and special follow-up on all assigned payer-type accounts to affect collection of patient and insurance account balances.
• Review and resolve all EOBs, including those without payment, to initiate clean claim resubmission and claim reimbursement.
• Demonstrate ability to edit and submit insurance claims for fee-for-service and prospective payment system reimbursement.
• Resolve unapplied cash, errors in cash reconciliation, and changes in payment allocation to insurance payer types.
• Communicate payment terms and establish agreed-upon payment plans for overdue patient and insurance account balances. Monitor payment compliance with terms of established plans.
• Evaluate uncollectible patient and insurance accounts and make recommendations concerning account write-offs and/or placement as bad debt status.
• Complete the bad debt process based on FCCH procedure.
• Document activities on accounts, including corrections and collection activities, in the practice management system and additional MS Word software tools provided.
• Initiate and complete account adjustments to correct account balances and/or comply with contractual and sliding fee scale requirements.
• Assist and train other staff members as requested in the areas of registration and billing.
• Assist Site Biller Representatives and cover their functions in their absence.
• Responsible for all other duties as assigned.

Requirements

• High school degree or GED.
• One to three years of data entry and billing/claims experience in a healthcare setting or FCCH billing externship. Education or knowledge may substitute for the experience requirement.
• Experience in a multispecialty clinic setting.

Preferred Qualifications

• Certified Coder (medical and/or dental).
• Billing Certificate from a certified billing school.
• Coder and/or Billing Certificate may be substituted with demonstrated proficient knowledge of procedural CPT & Dental Coding and/or ICD-10 diagnosis coding.

Skills

• General knowledge of computerized practice management systems, preferably Cerner PWPM Practice Management System, Cerner Electronic Health Record System, and Dentrix Dental billing and EHR.
• Ability to learn billing and collection systems within federally chartered community health centers (CHC) and RHI/UHI programs.
• Ability to communicate with tact and diplomacy with diverse groups, including staff, providers, and insurance companies on behalf of the organization. Ability to display sensitivity to the patient population being served.
• Ability to work on a variety of assignments concurrently within established deadlines.
• Ability to work with others in a problem-solving and team environment.
• Knowledge of HIPAA as it relates to medical, dental, and behavioral health billing.
• High level of accuracy and attention to detail.
• Ability to communicate effectively, both orally and in writing.
• Ability to respond effectively to sensitive inquiries or complaints.
• Ability to work independently with minimal supervision.
• Proficient with computers and MS Windows software programs.
• Knowledge of Federally Qualified Health Care billing and reimbursement (preferred).
• Working knowledge of CPT, Dental ADA, DSM V, and ICD-10 (preferred).
• Knowledge of Medicare and Medicaid guidelines.
• General knowledge of UB04, HCFA1500, and Dental ADA Electronic and Paper claim forms.
• Knowledge and familiarity with compliance programs. Cooperate fully and comply with laws and regulations.

Physical Characteristics / Working Conditions

A person in this position must be able to prioritize and respond to the diverse demands of the role. There are frequent opportunities to relax from physical exertion, change position in work activities, or take breaks from computer tasks.

• Physical Effort and Dexterity: Good dexterity to operate personal computers and office equipment. Occasional lifting and carrying related to office duties.
• Machines, Tools, Equipment: Capable of using office machines and personal computers for word processing, data entry, and spreadsheet applications.
• Visual Acuity, Hearing, and Speaking: Must be able to read a computer monitor and outputs accurately. Must be able to clearly and accurately communicate for work, safety, and compliance.
• Environment/Working Conditions: Work is mostly inside an office in a controlled environment. Normal office safety precautions and practices are required. Position requires travel throughout the Albuquerque metropolitan area. Work is regularly scheduled Monday-Friday, although weekends and evenings may occasionally be required to meet deadlines or attend meetings.