This position is responsible conducts thorough research of claims status to identify issues and takes corrective measures to obtain payment and ensures accuracy of future claims and compliance of the Centers for Medicare and Medicaid requirements for electronic and paper claim submission. In addition, ensures claims preparation is completed meeting the Centers for Medicare and Medicaid Services (CMS) Medicaid Final Rule with accuracy and goal zero errors and ensuring processing of Medicaid Managed Care (MCOs) claims and for the optimal payment of claims.
This position will uphold the mission and beliefs of the organization by accurately processing encounters information and capture all revenue opportunities following the department’s policies and procedures.
Verifies completeness, billing accuracy, and reimbursement of primary and secondary claims for assigned payers.
Ensure all claims are submitted with a goal of high accuracy and reimbursed at the proper rate and cash posting is completed.
Understand and apply payer coverage, rules, reimbursement policies and medical policies.
Daily billing and collections of all billable claims for primary and secondary payers.
Daily oversight of claims overpayment, underpayments and, denials.
Reviews Explanation of Benefits and resubmits claims for payment to proper insurance company on UB 92 and/or 1500 Claim Forms if appropriate.
Properly bills and reviews reimbursement for claims that are not eligible for electronically remittance.
Reviews all visits for assigned payers to ensure timely reimbursement of claims. Reviews claim denial patterns and reporting utilizing GE Denials IQ and AR Aging reports with keen attention.
Identifies root cause of the denial and addresses/report the denial issue with the appropriate payer/internal department and supervisor and timely follow up on insurance claim denials, exceptions or exclusions.
Assists in development of preventative measures in response to denial patterns identified by claims denial data and reviews.
Actively participates in meetings and/or seminars and disseminates denial reports and information to peers to enhance the knowledge and skills of the department.
Monitors and ensures electronic data exchange (EDI) and all claims have been successfully transmitted.
Incorporates Centricity Denials IQ software and reporting into claims rejection workflow.
Other duties as assigned
Monitors write-offs to ensure that AR follow-up has been thoroughly completed.
Ability to work professionally and collaboratively with department heads and others.
Two-three (2-3) years’ experience with Medical Insurance billing.
Associates Degree in related field or five (5) years of related experience.
Professional and effective oral and written communication skills
Organizational skills; ability to multi-task and manage priorities; meets critical deadlines
Proficient in Microsoft Excel, Outlook and Word and proprietary database applications.
Knowledge of Electronic Health Records a plus.
Family Practice and Counseling Network, a program of Resources for Human Development, is a network of federally qualified community health centers that uses a nurse-managed, integrated model to deliver primary care, behavioral health, dental, and preventive services, which are co-located at the centers and are designed to treat the whole patient.
Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status.