Job Description

TITLE : Medical Billing Specialist, on site in Kenai Alaska
REPORTS TO: CFO
WORK WEEK: Hours not to exceed 40 per week
WAGE CLASSIFICATION: Non-exempt, $21.00 per hour
OSHA RISK CLASSIFICATION: Low

SUMMARY POSITION STATEMENT

This position exists to ensure the financial well-being of the PCHS organization through timely and accurate filing of insurance claims and collection of patient accounts and ensure proper posting of payments into existing PCHS systems for medical, dental, optometry and/or behavioral health.  This position may be responsible for any or all the essential functions listed below in the electronic health record systems.  

ESSENTIAL FUNCTIONS/ROLES & RESPONSIBILITIES OF THE POSITION

• Collaborate with staff, providers, team members, patients and insurance companies to get all claims processed and paid. Capable of performing all aspects of medical billing independently, including but not limited to, charge entry, posting insurance payments, rejections and follow-up.
• Assign correct diagnosis (ICD-10) and procedure (CPT) codes based on direction from providers.  Must have specific knowledge of diagnostic and procedural terminology.  
• Monitor aging to ensure timely follow-up of claims resolution, reduction of future denials, ensuring accurate payment, and escalation of issues to management as identified. 
• Conduct insurance re-verification as needed through various tools and initiate billings to a new payer, reprocess the claim accordingly, or bill the patient. 
• Research payer guidelines and write and submit appeals as appropriate. 
• Manage collections. 
• Review and appeal unpaid and/or denied claims.
• Prepare, verify and submit prior authorizations.
• Verify patient coverage and insurance benefits.
• Answer patient billing questions
• Process refunds
• Handle collection efforts on all unpaid accounts and submit to Collections on a timely basis.
• Continuous data entry into state/federal/local reporting programs such as AKAIMS 
• Administrative responsibilities associated with meeting reporting requirements.
• Audit data when necessary and/or appropriate
• Generate, process and/or mail monthly statements.
• Knowledge of how to post in all electronic health record systems.
• Post payments, adjustments, and denials in systems as appropriate
• Balance daily deposits to daily postings for all systems
• Check allowables to ensure correct payment and account balances.
• Post zero pay correspondence as pertaining to: deductibles, copayments, and denials.
• Process credit card payments and balance credit card machine transactions daily
• Run weekly conveyance reports to verify everything is in balance for month end.
• Ensure that desktop procedures are current.
• Perform month end closing procedures.
• Perform duties as assigned by manager.

POSITION REQUIREMENTS

Education : High School Graduate.  Certified Medical Coder (AAPC or AHIMA coding/billing certificate) preferred but not required.
License : No license required.  Certificate preferred but not required.
Experience : 3-5 years of healthcare claims processing and/or coding/billing experience; FQHC experience preferred. 

Job Requirements:

• Must be computer literate, proficient with Microsoft Office Products and be able to type 45 wpm and must have 10 key skills.
• Possess a basic understanding of billing and collection rules and regulations. Knowledge of ICD-10, CPT, and HCPC Coding.  Medicare G-Coding experience preferred. 
• Knowledge of healthcare claims processing and provider contracts in Primary Care, Behavioral Health, Vision, and Dental.
• Experience with Electronic Medical Record Systems; ECW, Insync, and/or Eyecloud Pro preferred.
• Excellent time management skills and ability to multi-task and prioritize work independently.
• Proficiency with Office Suite, Excel, and Word.
• Strong organizational skills including attention to detail and multi-tasking skills.
• Pass a State required background check plus a pre-hire drug screen.

Contact:   Patty Eissler, HR Director, peissler@pchsak.org or 907-260-5017

PCHS is an equal opportunity employer and ADA compliant agency.

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