• ECW Experience preferred
• FQHC Experience preferred

Job Summary

This role is responsible for managing the claims edits and ensuring a clean claim is submitted to the payer to avoid payer rejections. This role will review demographic, insurance verification, charge capture, coding and billing edits prior to the claim submission to the payer.

Duties and Responsibilities

• Possess a knowledge of State(s) and Federal billing and reimbursement guidelines, including third party insurance plans as well as changes in policies and procedures, contracts and fee-schedules as designated by the plan and/or the management for the practice.
• Responsible for the day-to-day billing operations, which include but are not limited to the following:
• Review professional Fee for Service and Federally Qualified Healthcare Centers (FQHC) claims for charge posting to ensure accuracy and proper coding practices.
• Prepare and submit clean claims to third party payers electronically via the assigned clearinghouse in a timely manner.
• Ensure claim is billed to the correct payer and authorization is obtained when appropriate.
• Ensure claims are submitted on the correct claim form per payer’s requirements.
• Payer accepted claim report note: Confirm claims receipt status with payer within seven business days of billing.
• Work out of the designation work-queues as priority.
• Identify claims not falling in work queues for reporting to Manager.
• Responsible for reducing age receivables by aggressive and focused clean claim submission:

• Retrieval of confirmation reports and verification of claims and statement submission

• Review and evaluation of billing reports for errors and trends, and report issues to Manager.
• Escalate billing error trends to Manager.

Minimum Qualifications

• High School Diploma or equivalent required.
• Minimum of 6 years Healthcare billing and collections required.
• Knowledge of medical coding systems (CPT, ICD, HCPCS) and familiarity with medical terminology.
• Knowledge of healthcare compliance and regulations, including HIPAA.
• Excellent communication and interpersonal skills.
• Ability to work independently and as part of a team.
• FQHC billing and knowledge preferred.
• Certification in professional billing (CBC) preferred.
• eCW knowledge preferred.

Working conditions

This job operates in a professional office environment and/or in a remote capacity. This role routinely uses general office equipment.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates the computer, keyboard, copy and fax machine, phone, and other general office equipment.

Direct reports

None.