Under the supervision of the Patient Revenue Manager, the Patient Revenue Coordinator is responsible for preparing and submitting timely and accurate insurance claims to third party payers, assisting in the implementation of payer regulations, and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract, or other regulations or agreements. The Patient Revenue Coordinator works with the Patient Revenue Manager to resolve issues around denials in the clinic, ensure departments are informed regarding the billing in their units. S/he works with La Clinica’s external billing company to ensure all claims are processed in a timely manner.
Qualifications: Required Education and Experience:
- Associates degree
- Understanding of payer EOBs/Remits.
- Credentialing experience (CAQH, group and individual credentialing).
- Minimum of 3-5 years' experience using ICD-10, HCPCs, and CPT medical coding and billing.
- Experience using electronic medical records (EMR).
- Excellent oral, written, and telephone communication.
- Working knowledge of rules and regulations pertaining to the FQHC guidelines.
- Demonstrates ability to work independently with minimum supervision in a team-oriented environment and interrelates well with individuals with diverse ethnic and cultural backgrounds and needs.
Preferred Education and Experience:
- eCW experience
- FQHC knowledge
- Stong computer skills including Microsoft Word, Excel, and fast and accurate typing skills.
- Ability to prioritize and manage multiple tasks with efficiency in dealing with multiple facilities
- Ability to handle a large volume of project receiving and researching claims.
- 3-5 years of revenue cycle experience
- Bilingual English - Spanish
Duties and Responsibilities:
- Prepares and submits clean claims to various insurance companies either electronically or paper.
- Reviews and posts denials to accounts according to the EOB to ensure accurate payment status and account activity.
- Reviews and assigns claims that need provider attention via jellybeans in eCW.
- Prepares bank reconciliation log daily to report incoming insurance checks.
- Monitors aging reports and take necessary actions to guarantee payments of claims.
- Reviews accounts daily and makes phone calls to assigned insurance groups for insurance follow-up to determine claim adjudication.
- Assures compliance with applicable billing laws and regulations to maximize cash receipts.
- Contacts insurance carriers regarding non-payments and/or improper payment on claims.
- Identifies problem accounts with payers; investigates and correct errors follow-up on missing account information and resolves past-due accounts.
- Prepares reports to identify and resolve accounts receivable.
- Helps with year-end reports such as patient revenue reports, adjustments, aging report, etc
- Posts patient payments to accounts and applies payment to claims.
- Posts ERA payments, adjustments, and write offs to appropriate accounts.
- Prepares, reviews, and send patient statements.
- Reviews Telephone Encounters assigned for patient account follow up.
- Answers inquires by phone regarding past-due accounts and insurance guidelines.
- Transfers bills to secondary or tertiary accounts, if applicable.
- Makes adjustment to either patient or practice accounts based on internal reports and/or documentation.
- Responsible for reading and understanding various types of Explanation of Benefits.
- Keeps supervisor informed of areas of concern and problems identified.
- Assists in the preparation of monthly reports in order to ensure accuracy and timely processing of claims billed through the EMR.
- Prepares and distributes monthly Unlocked Encounters Report to ensure all visits are locked and ready to bill for the month.
- Maintains strict confidentiality regarding confidential conversations, documents, and files.
- Participates in educational activities and attends monthly staff meetings.
- Adheres to all HIPAA guidelines/regulations
- Perform other related duties as assigned