JOB SUMMARY: The Medical Biller participates in the delivery of excellent medical services in a patient centered medical home environment with an emphasis on the prevention of disease by serving as the primary responsible party for insurance claims processing and collecting. The Medical Biller is responsible for all medical billing within the clinic, including submitting claims, processing denials, updating patient accounts, and collecting/recording patient payments. The Medical Biller coordinates improvement in all areas of the clinic with an emphasis on the importance of the individual patient and putting their needs first.

DUTIES AND RESPONSIBILITIES:

Medical Biller Duties:

• Demonstrates proficiency with Electronic Medical Records (EMR) and when needed, enters data into computerized system.
• Posts charges and claims to payers in a correct and timely fashion; works claims and claim denials to ensure maximum reimbursement for services provided.
• Respond to questions and complaints from patients or insurance companies.
• Submits billing data/information to medical and insurance providers; requests any missing patient information as needed.
• Audits the front desk on collection of payment, entering patient information correctly into the EMR, and assigning appropriate insurance type(s) or SFS data.
• Manages the flow of the front desk and assists with patient complaints.
• Ensures internal controls are established and followed; ensures compliance with regulatory agencies.
• Coordinates collection efforts of accounts receivables
• Prepares monthly patient statements.
• Creates paper and electronic records of documentation related to billing/denials/payments, etc.
• Arrange payment plans and timelines for payments.
• Ensures correct codes are included in claims submitted to Medicaid/Medicare/Commercial; Performs Medicaid/Medicare audits as needed.
• In conjunction with the accounting department, reviews EOBs looking for trends.

Administrative Duties

• Maintains customer confidence and protects operations by keeping sensitive information confidential and always maintaining patient confidentiality.
• Develops and maintains a tracking and dating system for incoming and late payments.
• In conjunction with the accounting department, monitors and resolves financial discrepancies.
• Provides reports as requested to the Revenue Cycle Manager, Accountant, CEO, or Board of Directors regarding monthly billing, numbers of claims submitted, expected payments, issues, etc.

Other Duties:

• Promotes and demonstrates Hope values of: Gospel motivation, Prayer, Excellence, Stewardship, Patience, Thankfulness, Humility, Service, Dignity through Relationship and Hospitality and Joy
• Always maintains and ensures patient confidentiality
• Always Maintains a courteous and professional demeanor; greets individuals and patients as they enter and exit the clinic; facilitates appropriate communication and interpersonal skills with all staff members, volunteers, and patients
• Maintains a safe, secure, and healthy work environment by establishing and following standards and procedures; comply with legal regulations
• Ensures front office and clinic policies and procedures (as applicable) are always followed
• Updates job knowledge by participating in educational opportunities; reading professional publications
• Attends and actively participates in staff meetings.
• Performs all other duties as assigned.
• The Medical Biller ensures compliance with all 19 Health Resources and Services Administration (HRSA) Health Center Program Requirements.
• The Medical Biller is also expected to actively participate in and support quality improvement activities and the clinical practice team efforts emphasize the importance of the individual patient and putting the patient’s needs first.

QUALIFICATIONS:

• Fluency in English and Spanish - required
• Billing and Coding Certificate - required
• At least (1) one year experience in medical billing – preferred
• Experience in a similar healthcare environment - preferred

KEY COMPETENCIES FOR SUCCESS:

• Faith to believe that Hope is a ministry of God, exemplifying the love of Christ, and held and directed by the Holy Spirit.
• Knowledge of CPT, HCPCS and ICD-10-CM coding.
• Knowledge of medical billing, particularly for Federally Qualified Health Centers (FQHCs)
• Knowledge of and skill in operating the electronic medical record (EMR) system, office equipment (calculator, copy/fax machine, telephone), personal computer systems (word processor, databases, email)
• Outstanding ability to build interpersonal relationships at all levels.
• Excellent communication skills, both written and verbal.
• Demonstrated passion for community health care.
• Ability to think strategically and make good decisions under pressure and within established timelines.
• Ability to work independently and collaboratively through teamwork.
• Proven ability to maintain integrity and sense of calm in a fast paced and high-demand environment.
• Proven ability to manage performance goals and maintain an organized workflow.
• Ability to analyze and process high volumes of information; multi-task, manage priorities; follow through.
• Ability to interact with people from all ethnic backgrounds, ages, and lifestyles.

TYPICAL PHYSICAL DEMANDS:

Occasional standing, walking, lifting, reaching, kneeling, bending, stooping, pushing, pulling and lifting and/or moving up to 25 pounds. Frequent sitting. Manual dexterity. Good reading eyesight and vision for close work. Ability to communicate by speaking and hearing in person or on the phone. Ability to travel to various locations.