Billing Representative

A career at Community Health Centers offers a unique opportunity to join a team that makes a real impact in our community every day, by improving individuals' health while enhancing their quality of life.

Top Reasons to Work at Community Health Centers :

• No weekends for the majority of our centers, 10 Paid Holidays and early Fridays.
• A great benefits package that includes healthcare coverage, paid time off, paid holidays, retirement plan, and more.
• Competitive compensation with advancement opportunities and tuition / training reimbursement.
• Awarded “Best and Brightest Companies to Work for in the Nation” for 5 consecutive years.
• Awarded “Top 100 Workplaces for Growing Families” by Orlando Sentinel.
• Modernized and attractive health centers, that patients love.

Job Summary :

The Billing Representative will review all claims for billing accuracy and compliance. Responsible for filing and ensuring all third party payer claims are paid timely. Responsible for completion of all duties and reports listed on the Billing Guidelines.

Primary Responsibilities and Specific Duties :

• Reviews claims for accuracy in accordance with Medicare, Medicaid and Managed Care policies.
• Transfers balances to patient’s responsibility on non-covered items, benefits denied or charges applied to the deductible.
• Researches and ensures corrections are made on denied claims due to missing or incorrect information.
• Performs insurance collection (follow-up) function utilizing the collection system management and aging reports.  As a part of this function generates and reviews aging reports to submit to insurance carriers when appropriate and in accordance with established guidelines.
• Runs paper claims when necessary and submits claims to appropriate fiscal intermediary.
• Prepares all refund paper work for accounts payable and enters adjustments into the eClinical Works (eCW) System.
• Maintains current knowledge of all Medicare / Medicaid policies and procedure updates.
• Reviews and appropriately places account claims in the collection management system in eCW.
• Following collection guidelines, sends collection letters and establishes phone conversations concerning outstanding balances.
• Establishes payment arrangements with responsible parties for outstanding balances.
• Processes all returned mail according to established policy and procedure.
• Processes all incoming patient correspondence and answers all patients’ questions regarding their account balance.
• Processes electronic file for monthly patient statements.
• Makes necessary adjustments to correct patient accounts for correct billing.
• Provides recommendations to Patient Accounts Receivable Coordinator regarding account disposition (collection agency placement, write-off discharge, etc.).
• Reports billing challenges to the Patient Account Receivable Coordinator.
• Answers questions related to insurance and patient billing for all internal / external customers.
• Ensures accuracy of payments received from third party payers per contracts and current reimbursement rates.
• Posts contractual adjustments as required to Medicare, Medicaid, HMO, PPO and other accounts per contracts and current reimbursement rates.
• Collects and posts payments, and completes appropriate forms / reports and submits daily to Patient Accounts Receivable Coordinator and Bookkeeper.
• Performs all other duties as assigned.

Education : High School Diploma or equivalent is required.

Experience :

• One year of medical billing and collection background and experience in a physician practice setting is required.
• Or a combination of completed education in Medical Billing and Coding with experience on a combination on any of the following : posting charges, creation of claims and adjustments, collections, payment arrangements, payment posting or insurance verification.
• For a position with duties focused on dental billing, strong experience in dental is required and the medical billing and collection experience is preferred.
• Must be experienced in working with eClinical Works or other similar medical software products.
• Must have basic knowledge of medical terminology.
• Must have good communication and customer service skills.

Certification / Licensure :

• NA

Special Skills :

• Must understand the billing procedures for Medicare / Medicaid, Workers Compensation, HMOs, PPOs and other managed care and commercial insurance plans.
• Must have knowledge of state credit laws and regulations and generally accepted collection practices.
• Ability to read, understand, and follow oral and written instructions.
• Maintain patient confidentiality.
• Excellent communication and customer service skills.

Other requirements :

• Able to work flexible hours as needed.