Job Details

Position Responsibilities

• Organize clinic claims for electronic or hard copy fax/mail and ensure receipt by appropriate third-party payors.
• Review claims to ensure payor specific billing requirements are met.
• Maintain active follow-up of outstanding accounts receivable.
• Determine and apply appropriate adjustments.
• Manage assigned accounts receivable as assigned to meet or exceed individual and departmental goals.
• Review clinical documentation detail to ensure correct billing of procedures.
• Appeal and/or dispute denials and underpayments when appropriate.
• Adhere to timely follow up requirements as outlined by payor regulations for claims billing, resubmission and appeal.
• Assist patients with questions/payments on their accounts, and update accounts when necessary.
• Research and submit refunds for payment to meet regulatory requirements.
• Establish/maintain relationships with office and clinical staff.
• Obtain hospital authorizations when needed for claim billing.
• Assist patients with the arrangement of payment plans for outstanding balances as outlined by clinic policies.
• Collect monies owed by patients using third party software in accordance with all applicable third-party vendors, accounting and financial policies.
• Ensure internal policies and procedures are adhered to by third-party outsourced vendors.
• Process and post payments taken over the phone or virtually.
• Educate assigned front desk staff regarding billing issues when identified.
• Use of procedure ICD 10, CPT and Modifiers to meet compliance requirements and clean claim rates.
• Navigation and use of payor sites functionality.
• Determine eligibility/co-insurance/copayments and deductibles.
• Complete HCFA 1500 as required by insurance payor policy requirement.
• Complete accounts receivable follow-up exception reports.

Experience

Required

• None.

Preferred

• Two (2) years of medical billing and/or collection experience.

Education

Required

• High School Diploma or equivalent.

Special Qualifications

Required

• Proficient in front end (patient payments, demographic to file the claim) and back-office billing practices.
• Understanding of variances in state billing rules/requirements.
• Strong attention to detail.
• Strong drive to obtain all amounts owed to the organization.
• Ability to interpret payor explanation of benefits (EOB).

Preferred

• CPAR, CRCR, or equivalent.

Candidates who are hired are eligible to receive a Healthcare Financial Management Association (HFMA) membership and access to certification trainings.

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.