Central Billing Representative II

About the Role

The Central Billing Representative II, under the supervision of the Central Billing Supervisor, is responsible for all assigned patient accounts receivable functions. This includes reconciling, researching, correcting, and submitting third-party claims, as well as resubmitting errors or denied claims. The role involves communicating with insurance companies and government payers to resolve claim issues and ensure payment, correcting coding discrepancies, and providing customer service to patients by addressing billing inquiries.

Responsibilities

• Reconcile, review, research, coordinate, and justify changes to claim forms; submit completed claims to third-party payers.
• Follow up on claims denials, make corrections, obtain approvals, resubmit claims, and appeal denials through the payer-required process.
• Research unpaid claims; contact patients to obtain necessary information and secure payments or negotiate payment plans.
• Handle patient inquiries, complaints, and customer service issues.
• Maintain current knowledge of regulations for third-party payers, Medicare, Medicaid, and claims coding formats.
• Coordinate electronic patient statements monthly.
• Review credit balance reports and prepare refund requests for overpayments.
• Participate in billing Helpdesk support by documenting and responding to account inquiries via electronic, telephone, and written correspondence.
• Review assigned outstanding accounts receivable (A/R) to identify issues with various insurance payers (e.g., Medicare, Medicaid, Commercial, Contracts, Self-Pay).
• Perform routine and special follow-up on assigned payer accounts to collect patient and insurance balances.
• Review and resolve Explanation of Benefits (EOBs), including those without payment, to initiate clean claim resubmission.
• Edit and submit insurance claims for fee-for-service and prospective payment system reimbursement.
• Follow up on outstanding A/R for all payers, including self-pay, and resolve denials.
• Communicate payment terms and establish agreed-upon payment plans for overdue patients.
• Monitor payment compliance with established plans for patients and insurance representatives.
• Complete the bad debt process based on FCCH procedures.
• Initiate and complete account adjustments to correct balances or comply with contractual and sliding fee scale requirements.
• Perform all other duties as assigned.

Requirements

• High school diploma or GED.
• Two years of billing/claims experience in a healthcare setting or FCCH billing externship. Education or knowledge may substitute for experience.
• Experience in a multispecialty clinic setting.

Qualifications

• Certified Coder (medical and/or dental) preferred.
• Billing Certificate from a certified billing school preferred.
• Coder and/or Billing Certificate may be substituted with demonstrated proficiency in procedural CPT and ICD-10 diagnosis coding.

Skills

• General knowledge of computerized practice management systems, preferably Cerner, Cerner Electronic Health Record System, and EHR.
• Ability to learn billing and collection systems within federally chartered community health centers (CHC) and RHI/UHI programs.
• Strong communication skills with the ability to interact tactfully and diplomatically with diverse groups, including staff, providers, and insurance companies.
• Sensitivity to the patient population served.
• Ability to manage multiple assignments concurrently within deadlines.
• Team-oriented with problem-solving skills.
• Knowledge of HIPAA as it relates to medical, dental, and behavioral health billing.
• High level of accuracy and attention to detail.
• Effective oral and written communication skills.
• Ability to respond 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, DSM V, and ICD-10 preferred.
• Knowledge of Medicare and Medicaid guidelines.
• General knowledge of UB04, HCFA1500, and electronic/paper claim forms.
• Familiarity with compliance programs and adherence to laws and regulations.

Schedule

Work is regularly scheduled Monday through Friday.

Working Conditions

• Work is primarily performed inside an office in a controlled environment.
• Normal office safety precautions and practices are required.
• Frequent opportunities to relax from physical exertion, change positions, or take breaks from computer tasks.
• Good dexterity for operating personal computers and office equipment; occasional lifting and carrying related to office duties.
• Must be able to read computer monitors accurately and communicate clearly for work, safety, and compliance.