Anderson Hills Pediatrics' Expectations of all Employees: - Adhere to all Anderson Hills Pediatrics' Policies and Procedures
- Conduct self in a manner that represents Anderson Hills Pediatrics' core values at all times
- Maintain a positive and respectful attitude with all work-related contacts
- Consistently reports to work prepared to perform the duties of the position
- Meets productivity standards and performs duties as workload necessitates
Primary Function: Assists the Billing Manager with the claims submission and revenue cycle of the practice.
Major Duties and Responsibilities:
• Adherence to current HIPAA regulations and federal/state laws for patient protected health information (PHI) and/or medical records; adherence to all AHP policies/procedures as they pertain to patient PHI and the medical record; maintain strict confidentiality of all patient information
• Update patient demographic information including insurance coverage; make changes/corrections as needed; verify patient insurance benefits when applicable
• Process required referrals to specialists and/or facilities
• Audit charges from EMR for accuracy in CPT /ICD-10 / HCPCS coding
• Pursue any outstanding claims and/or appeal any denied or underpaid claims
• Respond to requests for medical records from insurance companies
• Post patient and/or insurance remittances
• File insurance claims daily
• Perform daily close of the day
• Investigate, analyze, and follow up for collection of overdue accounts
• Initiate and respond to telephone inquiries from patients, insurance companies, others
• Process BCMH applications as needed
• Participate in quality improvement initiatives as needed
• Complete necessary training on topics including, but not limited to, care coordination, patient self-management, population management, and health literacy
• Attend monthly staff meetings and scheduled department meetings
• Other miscellaneous duties as assigned by the Billing Manager
Principle Working Relationships - Works with patients/families, insurance companies and Finance Manager
- Works with physicians, other managers, and staff as needed
Qualifications: - Education: High school diploma
- 1-3 years of medical billing office experience preferred
- Coding certification required
- Experience in pediatrics preferred
Essential Skills and Abilities: - Demonstrate excellent listening skills and problem-solving skills
- Ability to interpret, adapt and apply guidelines and protocols
- Ability to willingly invest in change processes to improve efficiencies, compliance, and overall AHP performance
- Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with physicians, other employees, and patients
- Excellent critical thinking skills; exhibit sound judgment in decision making
- Excellent communication (both oral and written)
- Demonstrate strong customer service skills, including the ability to use appropriate judgment, independent thinking, and creativity when resolving customer issues
- Initiative and ability to work independently, lead/work in teams, and deal persuasively and effectively with all levels throughout the organization.
- Ability to manage multiple projects in varying stages of development; excellent problem-solving skills and attention to detail.
- Must be able to receive constructive criticism and react quickly to change.
- Ability to balance and shift multiple priorities.
Working Conditions: - Works in clinical areas as well as throughout the facility
- Sits, stands, bends, lifts and moves intermittently during work hours
- Relocation not available