Apply on Employer Site

Ashbaugh Beal · 3 months ago

Central Billing Representative II

Albuquerque, NM

Full-time

Onsite

Entry Level

2+ years exp

Ashbaugh Beal is seeking a Central Billing Representative II to manage patient accounts receivable functions under the supervision of the Central Billing Supervisor. The role involves reconciling claims, communicating with insurance companies, and providing customer service to patients regarding billing issues.

Law EnforcementLegalProfessional Services

Responsibilities

Reconcile, review, research, coordinate and justify changes to claim forms and submit completed claim forms to third party payers

Follow up on claims denials, make appropriate corrections, obtain approvals and resubmit claims denials for payment; appeal denials through the payer required appeals process

Research unpaid claims; contact patients to obtain necessary information to assist with the claims process; 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 knowledge of claims coding and formats

Coordinate electronic patient statements monthly

Review credit balance reports and prepare refund requests for overpayments

Participate in billing Helpdesk customer support, by receiving, responding and documenting all incoming account inquiries including electronic, telephone and written correspondence related to billing issues

Review assigned outstanding A/R to identify problems with various insurance payers (i.e. Medicare, Medicaid, Commercial, Contracts and Self-Pay). Perform all routine and special follow-up on all assigned payer type accounts to affect collection of patient and insurance account balances

Review and resolve all EOB’s including those without payment to initiate clean claim resubmission and claim reimbursement

Edit & submit insurance claims for fee for service and prospective payment system reimbursement

Follow up with outstanding A/R all payers and/or including self-pay and/or including resolution of denials

Communicate payment terms and establish agreed-upon payment plans for overdue patients

Monitor payment compliance with terms of established plans with patients and insurance plan provider representatives

Complete bad debt process based on FCCH procedure

Initiate & complete account adjustments to correct account balance and/or comply with contractual and sliding fee scale requirements

Responsible for all other duties as assigned

Qualification

CPT codingICD-10 codingBilling experienceCerner EHRHIPAA knowledgeMedicare guidelinesMedicaid guidelinesCustomer serviceAttention to detailTeamworkCommunication skillsProblem solving

Required

High school degree or GED

Two years in billing/claims experience in healthcare setting or FCCH billing externship

General knowledge of computerized practice management systems, preferably Cerner, Cerner Electronic Health Record System and E H R

Ability to learn billing and collection system within federally chartered community health centers (CHC) and RHI/UHI programs

Ability to communicate with tact and diplomacy with diverse groups of people 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 and to work alongside staff as needed

Knowledge of HIPAA as it relates to medical, dental & behavioral health billing

Position requires a 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, DSM V and ICD-10 preferred

Knowledge of Medicare and Medicaid guidelines