Job description
Position Summary:
The Revenue Cycle Associate is responsible for initiating automated claims processing activities using claims editing software for all CCHC claims in an efficient, accurate and time conscious manner while maintaining daily and weekly productivity standards established within the department for this position.
Responsible for seeking the maximum reimbursement on behalf of CCHC through various external and internal programs and payment plans with assisting patients with payment of their bills. The RCS will perform patient registration and verify insurance benefits. Resolve complex insurance related issues by working with appropriate parties within CCHC and insurance companies. Provide education and support to patients and clinical staff regarding financial policies.
Responsible for review clinical documentation to abstract and/or validate CPT and ICD-10 coding medical services. This position will ensure that medical records are coded in an accurate and timely manner as well as work closely with team to consistently and accurately resolve errors or issues associated with coding and billing processes, and when necessary, assist in the design and implementation of workflow changes to reduce billing errors.
Responsibilities Include but are not limited to:
- Payment Posting; Processing Claims; Charge Entry; AR Follow-up’ Insurance Verification
- Ensure that claims are transmitted electronically each day to the appropriate payer. Ensures that claims that cannot be billed electronically are printed and mailed as needed.
- Research, edits/corrects and transmits any claim rejected by the claims editing software in order to submit them timely to the appropriate intermediary, which include but are not limited to: Medicare, Medicaid and MCOs
- Ensure claims missing diagnosis or other required information are resolved.
- Denial activities as appropriate in the collection notes. Assists with balancing and reconciling claims processed as needed.
- Review documentation to ensure proper diagnostic and procedural coding, according to the appropriate classification system.
- Ensures accurate, timely and appropriate assignment of ICD-10, CPT/HCPCS codes and modifiers for the purpose of billing and compliance with regulatory and payer guidelines.
- Provides coding feedback to providers, clinical department leadership and revenue cycle team.
- Assists with implementation and design of workflow updates and coding tools.
- Escalate coding and documentation issues to revenue cycle leadership and assist facilitating corrective action plans.
- May be tasked with generating reports and/or analyzing data related to evaluation and management code utilization, CPT code application, denials and/or reimbursement per contracted terms, etc.
- Support revenue cycle team with coding related denials
- Completes billing for Ryan White services.
- Participates in Ryan White HIV/AIDS Program Target HIV RC trainings Special projects, as assigned
- This position is required to report on-site M-F
Minimal Qualifications/Experience/Skills
- High School Diploma/GED or equivalent
- Experience with medical billing and strong knowledge of claim cycle.
- Minimum of two (2) years billing experience; experience with Medicare/Medicaid billing strongly preferred
- Knowledge of FQHC services and coding, preferred.
- Knowledge of federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing with demonstrated ability to interpret such guidelines.
- Ability to manage and prioritize projects, as assigned.
- Strong verbal, written, organizational and communication skills.
- Athena EHR knowledge, a plus
- Capable of working in team focused environment Working knowledge of Excel, Word, Data Entry and computerized health care billing software knowledge.
- COVID-19 vaccination and negative TB results are conditions of employment.
CCHC is committed to:
- Respectful, Compassionate and Quality Care
- Affordable and Equitable Services and Treatment
- Culturally Appropriate and Comprehensive Community Based Services Service Integrity Offered by Qualified, Dedicated Staff
- A Safe and Welcoming Environment for All
CCHC is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, gender identity, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
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