Medical Biller

About the Role

The Medical Biller participates in the delivery of excellent medical services in a patient-centered medical home environment, emphasizing disease prevention. This role serves as the primary responsible party for insurance claims processing and collecting, ensuring efficient billing operations within the clinic.

Responsibilities

• Demonstrates proficiency with Electronic Medical Records (EMR) and enters data into the computerized system as needed.
• Posts charges and claims to payers accurately and timely; works claims and claim denials to ensure maximum reimbursement for services provided.
• Responds to questions and complaints from patients or insurance companies.
• Submits billing data/information to medical and insurance providers; requests any missing patient information as needed.
• Audits the front desk on collection of payment, entering patient information correctly into the EMR, and assigning appropriate insurance type(s) or sliding fee scale (SFS) data.
• Manages the flow of the front desk and assists with patient complaints.
• Ensures internal controls are established and followed; ensures compliance with regulatory agencies.
• Coordinates collection efforts of accounts receivables.
• Prepares monthly patient statements.
• Creates paper and electronic records of documentation related to billing, denials, payments, etc.
• Arranges payment plans and timelines for payments.
• Ensures correct codes are included in claims submitted to Medicaid, Medicare, and commercial insurers; performs audits as needed.
• Reviews Explanation of Benefits (EOBs) with the accounting department to identify trends.
• Maintains customer confidence and protects operations by keeping sensitive information confidential.
• Develops and maintains a tracking and dating system for incoming and late payments.
• Monitors and resolves financial discrepancies in conjunction with the accounting department.
• Provides reports as requested to the Revenue Cycle Manager, Accountant, CEO, or Board of Directors regarding monthly billing, claims submitted, expected payments, and issues.
• Promotes and demonstrates Hope values: Gospel motivation, Prayer, Excellence, Stewardship, Patience, Thankfulness, Humility, Service, Dignity through Relationship, Hospitality, and Joy.
• Maintains patient confidentiality at all times.
• Maintains a courteous and professional demeanor; greets individuals and patients; facilitates appropriate communication and interpersonal skills with staff, volunteers, and patients.
• Maintains a safe, secure, and healthy work environment by following standards and procedures and complying with legal regulations.
• Ensures front office and clinic policies and procedures are followed.
• Updates job knowledge by participating in educational opportunities and reading professional publications.
• Attends and actively participates in staff meetings.
• Performs all other duties as assigned.
• Ensures compliance with all 19 Health Resources and Services Administration (HRSA) Health Center Program Requirements.
• Actively participates in and supports quality improvement activities and clinical practice team efforts, emphasizing the importance of individual patient needs.

Requirements

• Fluency in English and Spanish (required).
• Billing and Coding Certificate (required).
• At least one year of experience in medical billing (preferred).
• Experience in a similar healthcare environment (preferred).

Skills

• Faith-based commitment to Hope’s mission as a ministry of God.
• Knowledge of CPT, HCPCS, and ICD-10-CM coding.
• Knowledge of medical billing, particularly for Federally Qualified Health Centers (FQHCs).
• Proficiency in operating EMR systems, office equipment (calculator, copy/fax machine, telephone), and personal computer systems (word processor, databases, email).
• Outstanding ability to build interpersonal relationships at all levels.
• Excellent written and verbal communication skills.
• Demonstrated passion for community health care.
• Ability to think strategically and make decisions under pressure within established timelines.
• Ability to work independently and collaboratively through teamwork.
• Proven ability to maintain integrity and composure in a fast-paced, high-demand environment.
• Proven ability to manage performance goals and maintain an organized workflow.
• Ability to analyze and process high volumes of information, multitask, manage priorities, and follow through.
• Ability to interact with people from diverse ethnic backgrounds, ages, and lifestyles.

Physical Demands

• Occasional standing, walking, lifting, reaching, kneeling, bending, stooping, pushing, pulling, and lifting/moving up to 25 pounds.
• Frequent sitting.
• Manual dexterity.
• Good reading eyesight and vision for close work.
• Ability to communicate by speaking and hearing in person or on the phone.
• Ability to travel to various locations.