Billing Specialist and Front Office Supervisor

Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services. The PIHC model of care assures that persons with HIV have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes.

JOB SUMMARY : Certified Medical Billing Specialist will be responsible for medical billing, coding and credentialing. Responsible for improving current billing procedures and reduce A / R days. Responsible for data analysis, in-depth evaluation and exercising judgement within the appropriate scope of practice. Prepare and maintain reports of credentialing activities such as accreditation, membership or facility privileges. Coordinates credentialing / peer review / recommendation processes per established policies and procedures. Provide direct supervision to the front office personal.

This position description should not be interpreted as all inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbents may be requested to perform job-related responsibilities and tasks other than those stated in this position description.

Requirements

ESSENTIAL FUNCTIONS :

Financial Responsibilities

• Provide patient's statements, - Print out Insurance A / R and Patient A / R. Review all items over 150 days.
• Responsible for medical billing and coding, Patient billing in EMR software (Cerner SPM & Power Chart).
• In coordination with Clinic Office Associate Review Outpatient Medical Referrals / invoices.
• Responsible for contacting Patients to collect payments, contact patients with past due balances and setup payment plan.
• Process ERA reimbursements; track payments by third party payers, follow up on denied third party claims and monitor patient annual caps.
• Assist patients with understanding fee payment policies and clinic services. Secure signed release of information from all new patients; renew annually.
• Assist with completion of patient paperwork and data entry necessary for management information and financial management systems.
• Collect monies from patients and for HIV testing. Patients are billed on sliding fee scale, collect payments, and process reimbursements.
• Enter data with proprietary billing software and communicate with providers, nurses, and other healthcare professionals to categorize the services a patient has received.
• Submit claims to insurance companies and apply CPT, HCPCS, and ICD-10 CM standardized codes to patient records to accurately reflect the services received.
• Following up with patients, healthcare professionals, and insurance providers to make sure claims are paid for and set- and enter data through Electronic Health Record (EHR) and Electronic Medical Record (EMR) software (Cerner SPM & PowerChart).
• Manage account payments and invoices and examine reports to apply procedure codes.
• Investigate rejected or denied claims and perform medical chart audits when a claim is denied.
• Ensure that providers and patients receive reimbursements from insurers and remain up-to-date with the latest revisions to coding standards and federal regulations.
• Verifying the accuracy of standard healthcare codes used by medical coders to classify services and products and examine patient charts and histories to ensure coding accurately reflects a patient's medical care.
• Prepare and maintain reports of credentialing activities such as accreditation, membership or facility privileges.
• Coordinates credentialing / peer review / recommendation processes per established policies and procedures.
• Ensures integrity of all paper and electronic practitioner files in accordance with medical staff bylaws, policies, and procedures.
• Responsible for credentialing new and existing providers
• Review medical appointments for needed certification and / or eligibility updates. Review weekly appointments to verify we possess current client income.
• Complete cash out procedures.
• Prepare reports and assist in grant preparation.
• Attend at least 4 hours of HIV specific training annually.
• Front Office Supervision Responsibilities
• Provide training to new staff and act as a mentor on topics such as how to respond to patient and prospective patients; review current procedures to help reduce wait time and make medical processes more efficient.
• Ensure coverage of the front desk by overseeing staff scheduling, greet clients; schedule appointments; open and close office; Clean and Organize reception area after unlocking front door.
• Ensure the front desk associates are completing all the necessary forms to include concert forms, eligibility form etc. Forms to be filled accordingly.
• Cross train the front desk associates.

Other Responsibilities

Knowledge, Skills, and Abilities

Minimum Qualification / Education and Experience

Associate Degree (Bachelor's Degree in Business or related field preferred)

And

Two years of experience needed as a Medical Biller / Coder and Credentialing, Medical Front Office Experience preferred. with Medicaid / Medicare knowledge a plus.

Or

Any equivalent combination of training and experience which provides the required knowledge, skills, and abilities.

Certifications

Certified Billing / Coding and Credentialing

Physical Demands : The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk, use hands to finger, handle, or operate computers, objects, tools, or controls and reach with hands and arms.

The employee must occasionally lift and / or move up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

NOTES :