Central Billing Representative II

For more than 50 years First Choice Community Healthcare has provided access to high quality primary medical dental and behavioral healthcare to the underserved populations of the MidRio Grande Valley of central New Mexico. Today we operate seven (7) Community Health Centers and one (1) schoolbased clinic. We are currently recruiting for a Central Billing Representative II to join our team and assist in fulfilling our organizations mission which is to improve the health life skills and wellbeing of all members of the communities we serve. Our health centers maintain an opendoor policy providing treatment regardless of an individuals income or insurance coverage. As a nonprofit organization First Choice is a vital community resource in Central New Mexico. Not only does our organization provide the highest quality comprehensive medical services but we also address our patients emotional social and cultural needs.

In addition to serving a communitycentered organization we offer an excellent benefits package to include:

Benefits Offered

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Flexible Spending Account
• Employee Assistance Program
• Aflac
• Life and AD&D Insurance
• Voluntary Life Insurance
• Identity Theft
• Retirement Savings 403(b)
• 1020 days per service year (based on length of service)
• Sick Leave 64 hours per year (unused rolls over each year into Long Term Sick Leave)
• Long Term Sick Leave 40 hours per year
• 10 Paid holidays per year
• 40 hours of Educational Leave per year for full time employees
• $700 per year for tuition reimbursement

A. POSITION SUMMARY

Under the supervision of the Central Billing Supervisor who reports to the Director of

Revenue Cycle Management the Central Billing Representative II is responsible for all

patient accounts receivable functions as assigned. Reconcile research correct and submit

third party claims and resubmit errors or denied claims. Communicate with insurance

companies and government payers to resolve claim issues and ensure payment. Research

and correct ICD10 CPT coding modifiers revenue coding occurrence codes and value

codes as appropriate. Provide customer service to patients by researching billing issues and

resolving the issues. Reconcile remittance advice and patient accounts and resolve

discrepancies.

B. ESSENTAIL DUTIES AND RESPONSIBILITIES

• Reconcile review research coordinate and justify changes to claim forms and submit

completed claim forms to third party payers.

• Follow up on claims denials make appropriate corrections obtain approvals and

resubmit claims denials for payment; appeal denials through the payer required appeals

process.

• Research unpaid claims; contact patients to obtain necessary information to assist with

the claims process; secure payments or negotiate payment plans.

• Handle patient inquiries complaints and customer service issues.
• Maintain current knowledge of regulations for Third Party Payers Medicare Medicaid

and knowledge of claims coding and formats.

• Coordinate electronic patient statements monthly.
• Review credit balance reports and prepare refund requests for overpayments.
• Participate in billing Helpdesk customer support by receiving responding and

documenting all incoming account inquiries including electronic telephone and written

correspondence related to billing issues.

• Review assigned outstanding A/R to identify problems with various insurance payers (

i.e. Medicare Medicaid Commercial Contracts and SelfPay). Perform all routine and

special followup on all assigned payer type accounts to affect collection of patient and

insurance account balances.

• Review and resolve all EOBs including those without payment to initiate clean claim

resubmission and claim reimbursement.

• Edit & submit insurance claims for fee for service and prospective payment system

reimbursement.

• Follow up with outstanding A/R all payers and/or including selfpay and/or including

resolution of denials.

• Communicate payment terms and establish agreedupon payment plans for overdue

patients.

• Monitor payment compliance with terms of established plans with patients and

insurance plan provider representatives.

• Complete bad debt process based on FCCH procedure.
• Initiate & complete account adjustments to correct account balance and/or comply with

contractual and sliding fee scale requirements.

• Responsible for all other duties as assigned.

C. MINIMUM EDUCATION AND EXPERIENCE

• High school degree or GED.
• Two years in billing/claims experience in healthcare setting or FCCH billing externship.

Education or knowledge may be substituted for the experience requirement.

• Experience in a multispecialty clinic setting.

D. PREFERRED LICENSE/CERIFICATIONS

• Certified Coder (medical and/or dental).
• Billing Certificate the result of graduation from a certified billing school.
• Coder and/or Billing Certificate may be substituted with demonstrated proficient

knowledge of procedural CPT & ICD10 diagnosis coding.

E. KNOWLEDGE SKILLS AND ABILITIES

• General knowledge of computerized practice management systems preferably Cerner

Cerner Electronic Health Record System and E H R.

• Ability to learn billing and collection system within federally chartered community

health centers (CHC) and RHI/UHI programs.

• Ability to communicate with tact and diplomacy with diverse groups of people including

staff providers and insurance companies on behalf of the organization. Ability to

display sensitivity to the patient population being served.

• Ability to work on a variety of assignments concurrently within established deadlines.
• Ability to work with others in a problem solving and team environment and to work

alongside staff as needed.

• Knowledge of HIPAA as it relates to medical dental & behavioral health billing.
• Position requires a high level of accuracy and attention to detail.
• Ability to communicate effectively both orally and in writing.
• Ability to respond effectively to sensitive inquiries or complaints.
• Ability to work independently with minimal supervision.
• Proficient with computers and MS Windows software programs.
• Knowledge of Federally Qualified Health Care billing and reimbursement preferred.
• Working knowledge of CPT DSM V and ICD10 preferred.
• Knowledge of Medicare and Medicaid guidelines.
• General knowledge of UB04 HCFA1500 and Electronic and Paper claim forms.
• Knowledge and familiarity with compliance program. Cooperate fully and comply with

laws and regulations.

F. AGE OF PATIENT SERVED

N/A

G. PHYSICAL CHARACTERISTICS/WORKING CONDITIONS

A person in this position must be able to prioritize and respond to the diverse demands of the

position. There are frequent opportunities to relax from any physical exertion change position in

work activities or break from computer application tasks.

1. Physical Effort and Dexterity: Good dexterity to operate personal computer

and office equipment. Occasional lifting and carrying related to office duties.

1. Machines Tools Equipment required to be operated: Capable of using office

machines and personal computers for word processing data entry and

spreadsheet applications.

1. Visual Acuity Hearing and Speaking: Must be able to read a computer

monitor and outputs accurately. Must be able to clearly and accurately

communicate for work safety and compliance.

1. Environment/Working Conditions: Work is mostly inside an office in a

controlled environment. Normal office safety precautions and practices are

required. Work regularly scheduled MondayFriday.

This description lists the major duties and requirements of the job and is not allinclusive.

Applicants may be expected to perform jobrelated duties other than those contained in this

document and may be required to have specific jobrelated knowledge and skills