SCOPE / GENERAL PURPOSE OF JOB:

Responsible for timely daily claim submissions and file maintenance functions of the business office in accordance with RC Billing standards and Reimbursement policy and procedures, including patient billing/EPS, claim submissions electronic and paper, and file maintenance.  Is responsible for seeking resolution to problems relating to timely and efficient claim submissions while ensuring excellent communication between the AR department, CBO management, Revenue Cycle IT Department and the Revenue Cycle Credentialing Department while ensuring client satisfaction. Responsible for timely completion of all client Allscripts Tiger database file builds and Practice Insight file builds to include documentation and follow-up processes through to completion.  Responsible for daily file maintenance within Allscripts Tiger and Practice Insight.  Responsible for ensuring daily claim submissions for all clients are successful and monitoring denials to ID trends and/or resolution is being sought timely by the AR Department.   Responsible for balancing, daily/monthly closing of all databases and preparing month end reporting packages.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

•  Ensures that daily, weekly, and monthly insurance AR and patient AR billing functions are performed as scheduled and accurate. 
• Demonstrates thorough understanding of claim submission functions compliant with Federal and State regulations and RC Billing policies and procedures. 
• Ensures daily receipt and accurate balancing of clearinghouse EDI reports and payer reports. 
• Ensures timely daily resolution of clearinghouse EDI edit reports and payer edit reports and claims are re-queued for timely claim submission. 
• Prepares and maintains the daily claim submission log per client ensuring all claims are received at the clearinghouse and payer levels for adjudication. 
• Ensures that all claims are submitted electronically for all payers accepting electronic submissions. 
• Notifies the Credentialing/Contracting Department and management of any clearinghouse enrollments (EDI & ERA) necessary to accomplish electronic submission and electronic remit advice for existing and new clients. 
• Notifies the Credentialing/Contracting Department of any physician and/or payer credentialing issues for resolution. 
• Prepares and maintains the Daily Patient Statement Log per client. 
• Completes month end close processes as assigned and recognized this positions requires overtime and no paid time off (PTO) during the month end closing schedule. 
• Completes initial database build and maintains database file for all clients.  and physician and maintain going forward. 
• Ensures strong communication between CBO management team, RCB IT and Credentialing/Contracting Departments and promptly responds to any and all high priority issues with immediate response and planned resolution. 
• Ensures compliance with RC Billing Reimbursement Policies and Procedures to maximize efficiency.
• Ensures compliance with appropriate industry regulations and State and Federal regulations. 
• Maintains working day to day knowledge of the practice management system. 
• Maintains working knowledge of applications laws and regulations as they relate to assigned responsibilities. 
• Maintains confidentiality of all information related to patients, medical staff, finances and cost effective health care delivery issues. 
• Strives to achieve and maintain company Daily Sales Outstanding and AR aging standards. 
• Strives to achieve CBO goals
• Additional duties as assigned. 

Education and/or Experience 

• High school diploma or equivalent 
• Minimum four (4) years application medical CBO experience 

Qualifications 

• Knowledge of organization policies and procedures.
• Knowledge of healthcare administration principles.
• Knowledge of business office procedures. 
• Knowledge of insurance agency operating procedures and practices. 
• Skill in exercising initiative, judgement, discretion and decision making to achieve business unit objectives. Skilled in identifying and resolving problems. 
• Ability to communicate effectively and professionally but verbally and written. 
• Ability to establish and maintain effective professional working relationships with all employees and clients.
• Knowledge of CPT-4 and ICD-10 coding. 
• Knowledge of Allscripts, Allscripts Pro PM, Misys/Tiger and Practice EDI Insight preferred.