Medical Biller II

Affiliate Wide - Revenue Cycle

Job Type

Full-time

Description

Medical Biller II Affiliate Wide

Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment.?No matter what.

In support of PPCWNY's mission, the Medical Biller II has the overall responsibility to ensure effective billing and collections on all patient accounts.

Essential Functions

Reviews all Tasks assigned to the individual/workgroup.

Aggressively follows up on all unpaid accounts to ensure that the A/R benchmark targets are met or exceeded.

Answers patient calls and address questions related to insurance and patient responsibility.

Works in conjunction with other staff to successfully meet internal goals.

Performs all duties in accordance with established agency policies, protocol and the In This Together services ethos, workplace values, and service standards.

Notifies Billing Manager of any collection or workflow issues.

Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs

Insurance Tasks:

Runs assigned reports to review all unbilled patient transactions for accuracy and completeness of charges and appropriateness of coding, correcting errors as needed

Verifies Insurance coverage to make sure coverage is effective for the billable date(s), appropriate for the services provided and all policy details are entered accurately

Addresses any claim edits that occur prior to filing claims, or that are a result of creating claims

Files clean claims electronically and on paper when necessary, using the NextGen EPM system or any other practice management systems clients are utilizing, and various clearinghouse applications as applicable

Posts payments from insurance companies

Applies payments and adjustments accurately from the remittance

Reviews to make sure that the charges roll appropriately to the next responsible party

Makes eligible sliding fee adjustments

Makes sure the batch balances

Maintains awareness of contracted reimbursement rates, follows up on discrepancies and notifies supervisory when there are unresolved issues

Works rejected claims and denials received on remittances

Performs timely follow up on outstanding unpaid claims; resubmits or appeals claims as needed in accordance with payer requirements

Patient Billing and Cash Application:

Works credit balances on a timely basis to ensure overpayments are addressed

Makes follow-up phone calls and sends past due letters on accounts with outstanding balances according to patient collections policies and procedures

Reviews accuracy of patient accounts prior to generating statements

Processes patient payments, returned checks, small balance write-offs and bad debt adjustments in accordance with established policies and procedures

Other Accountability Activities

Attends and participates in team meetings and other required meetings or training opportunities including education on insurance rules and regulations

Assists with training of other staff

Participates in affiliate initiatives

Performs other duties as assigned by the Billing Manager

Builds and maintains positive, quality relationships with customers, both internal and external

Adheres to PPCWNY safety and security rules, policies, and procedures and HIPAA confidentiality standards

Requirements

Qualifications

Applicants must possess the following qualifications (or equivalent combination of education and experience):

Education

Associate's degree in business, accounting, business administration, or a related field or equivalent combination of education and experience

Experience

Minimum three years of experience in medical billing/collections

Minimum three years of experience with computerized billing/receivables system and reports

Experience with NextGen practice management system preferred

Certifications

Ideal candidate will have one of the following certifications but is not required: Registered Health Information Administrator (RHIA), Certified Health Information Technician (CHIT), Certified Coding Specialist (CCS), Certified Medical Billing Specialist (CMBS), or Certified Professional Coder (CPC)

Knowledge, Skills, & Abilities

Minimum three years of experience in medical billing/collections

Minimum three years of experience with computerized billing/receivables system and reports

Experience with NextGen practice management system preferred

Must be sensitive to patient's financial and clinical needs while maintaining the patient's confidentiality

Experience in insurance guidelines and programs (i.e., Medicaid and Medicare)

Knowledge of ICD-9/10, HCPCS and CPT codes

Extensive experience with follow-up on unpaid claims within standard billing cycle timeframes

Extensive experience with appealing insurance companies for denied claims

ERA payment posting experience

Must be able to multi-task and work in a fast-paced environment effectively under deadlines

Accuracy and attention to detail is essential

Extensive experience in researching issues and providing resolutions

Strong analytical and problem-solving skills

Must be able to work independently and as a team player

In-depth knowledge of Government and non-Government payer sources

Experience working with databases and Microsoft Office (i.e., Excel and Word)

Ability to work a flexible schedule (i.e., early mornings and evenings)

Must have top-notch customer service and follow-up skills

Ability to read and interpret medical procedures and terminology

Planned Parenthood seeks candidates who are proficient in two or more languages

Working Conditions

Standard office environment

May experience visual fatigue working at computer with potential extended periods of sitting

Well-lit/ventilated

Physical Requirements

Ability to lift 10 pounds with or without an accommodation

Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without an accommodation

Ability to travel to all agency locations and donor/prospect locations as assigned

Work Schedule This is a full-time (40 hours per week) position; regular schedule will be Monday - Friday with occasional evenings and weekends. Benefits & Compensation At PPCWNY, we are committed to equitable compensation practices and transparency. ?In alignment with these efforts, the pay for this position ranges from $21.89 - $25.36/hr. Actual compensation will be determined by experience and other factors permitted by law. In addition to competitive compensation, PPCWNY offers an extensive benefits package with generous Paid Time Off, 10 paid holidays, affordable medical, dental, and vision options, Health Savings Account or Flexible Spending Account, 401(k) with match, and much more!

Planned Parenthood of Central and Western New York is an equal opportunity employer.

Salary Description

$21.89 - $25.36

Planned Parenthood of Central and Western NY

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