GENERAL STATEMENT OF DUTIES

Under general supervision the Billing Specialist is responsible for timely submission of claims to insurance companies from a wide variety of medical providers and facilities, as well as monitoring and ensuring, that payments for medical services are received in a timely manner. Billing Specialist may also function as an intermediary between healthcare providers, clients, patients and health insurance companies.

GENERAL DUTIES

(This list may not include all of the duties assigned.) Reviews patient charges for accuracy and completeness; obtains missing information. Knowledge of insurance, especially compliance of Medicare and Medicaid, rules and guidelines. Identify insurance company or proper party (patient) to be billed; identify and bill secondary or tertiary insurances. Perform coding and billing tasks on a computerized health information technology (HIT) system. Provider and facility credentialing with third party payers and maintenance of organized files and a credentialing progress grid. Third party payers contracting duties as assigned. Utilize a combination of electronic health record (EHR) and paper patient records to perform billing duties; maintain an accurate, legally compliant medical record. Process claims as they are paid and credit accounts accordingly. Review insurance payments for accuracy and compliance with contract discounts. Review denials or partially paid claims and work with the involved parties to resolve the discrepancy. Manage assigned accounts, ensuring that outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment. Assist patients and staff in completing sliding fee applications and process the application in accordance with Western Sierra Board approved policy. Communicate with health care providers, patients, insurance claim representatives and other parties to clarify billing issues and facilitate timely payment. Consult supervisor, team members and appropriate resources to solve billing and collection questions and issues. Maintain work operations and quality by following standards, policies and procedures; escalate compliance issues to supervisor. Prepare reports and forms as directed and in accordance with established policies. Perform a variety of administrative duties including but not limited to: answering phones; faxing and filing of confidential documents; and basic Internet and email utilization. Provide excellent and professional customer service to internal and external customers. Function as contributing team member while meeting deadlines and productivity standards. Submit twice daily claims batches to all insurance carriers. Prepares insurance adjustments reports to Chief Financial Officer/Controller. Assists in insurance contract renewals and additions, as needed. Answer and direct phone calls. Documents all pertinent information in patient's electronic medical record according to WSMC's policies and procedures. Upholds WSMC's Policies and Procedures, infection control standards, applicable state, federal and local laws.

Quality Improvement Duties:

Participates in quality improvement activities; Participates as assigned in interdepartmental quality improvement team efforts; and Contributes to overall Community Health Center efforts in quality improvement towards higher-quality, more cost-effective health care for patients and improved quality of work-life for staff members. Other duties as assigned.

MINIMUM QUALIFICATIONS

Education:

High school diploma or equivalent. Successful completion of program in medical billing; current Certified Medical Reimbursement Specialist (CMRS) certification; Training and experience in a FQHC setting preferred: Unless otherwise indicated, one year of current experience within the last three years in a comparable job classification required. Computer literate, email, MS Office and data entry skills required. Ability to type 45 wpm and utilize a ten-kay calculator. Educated on and compliant with HIPAA regulations; maintains strict confidentiality of patient and client information. Educated on and compliant with Medicare and Medicaid billing regulations and requirements.

DESIRED EXPERIENCE

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