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About the Role

Be a part of the mission at Whitney Young Health (WYH) to provide high quality healthcare that is affordable and accessible to our diverse community.

Responsibilities

• Ensures the financial integrity and Accounts Receivable by performing established financial processes that enable and expedite the billing and collection of medical services.
• Creates claims according to regulations and compliance guidelines.
• Performs patient account research and resolution.
• Conducts insurance verification and benefit determinations.
• Identifies reimbursement issues.
• Resolves credits and issues refunds.
• Identifies payment variance invoices.
• Follows up and resolves denied claims.
• Works correspondence denials and insurance follow up in a timely and accurate manner.
• Assists with the training and orientation of employees on billing functions.
• Responsible for encounter/claims creation and billing in correct format as required by payer.
• Inputs, reviews and updates all demographic and insurance data as necessary.
• Processes pending claims as directed by Director and/or Manager of Revenue Cycle.
• Responsible for timely submission of claims to the clearing house and reconciling clearing house reports.
• Monitors and executes work against assigned Tier(s) and team associated Custom Claim Worklist(s), relational AR Worklist(s), reporting, projects, or team / department goals.
• Oversight of HOLD/Tier 1 Worklists and monitors Missing Slips to ensure timely charge capture.
• Reviews and adjudicates clearinghouse rejections.
• Processes third party payments, denials, and carrier inquiries via receipt of ERA, paper, and any pertinent method.
• Contacts payers via phone or website, contacts practices, navigates cross-departmentally, writes appeals and facilitates their direction to Athena CBO for submission, and all other activities that lead to the successful adjudication of eligible claims.
• Informs Director of reasons for claims denials and other changes in claims adjudication including recommending claims for write off.
• Works and resolves unpostables, manages remittance and all correspondence in each of the dashboards daily.
• Works and resolves Zero-Pay Worklist, Fully Worked Receivables, completes special project work, reviews and responds to adjustments / payment data with approval (or initiate appeal) communicates trends and root issues through proper lines of reporting.
• Receives calls or emails from Patient Financial Specialists with patients requesting advanced assistance with their account.
• Reconciles employees’ medical and dental accounts including posting employee payments, applying employee dental discounts based and adjusting non-billable services/vaccines that are required by WYH for employment purposes and co-pays when appropriate.
• Develops solutions to claim processing and payer adjudication problems.
• Learns and keeps up to date on payer billing requirements, changes in medical/dental practices, and coding.
• Assists with the implementation of any and all process improvement initiatives including developing policies and procedures.
• Reviews and transfers patient charges over 120 days to collection vendor as instructed by Director and/or Manager Revenue Cycle.
• Completes patient itemized statements upon request.
• Manages/Assists on supplemental claims billing as instructed by Director and/or Manager Revenue Cycle.
• Assists in working with other departments to resolve inquiries from staff and/or patients (i.e. accounting, IA’s).
• Works in a collegial and cooperative manner with staff in the department and throughout WYH.
• Completes all other patient accounts functions and steps not specifically identified above but resulting from continuous performance improvement activities and periodic training sessions.
• Participates in monthly staff meetings and attends monthly payer meetings as requested by the Director of Revenue Cycle.
• Provides support to other staff to include additional training, back up, and other assistance as needed.
• Learns and keeps up to date on all programs and services offered at WYH.
• Available to work overtime as needed.
• Demonstrates excellence in both internal and external customer service.
• Tracks weekly production and sends report to Director Revenue Cycle for weekly quality and productivity review.
• Keeps management informed of correspondence and communication problems with service locations.
• Maintains productivity and quality standards.
• Maintains knowledge and understanding of insurance billing procedures to understand the reason for claims in HOLD, MGRHOLD and OVERPAID status to ensure resolution and timely payment.
• Understands and is able to effectively communicate HIPAA compliance, corporate compliance and client confidentiality.
• Ensures and/or remains in compliance with local, state, and federal regulations.
• Adheres to the National Patient Safety Goals as defined by the Joint Commission and the Whitney M. Young Jr. Health Center.
• Completes other duties as assigned.

Requirements

• High school diploma or GED.
• Excellent oral and written skills.
• Competent in use Microsoft Office applications, especially Excel.
• Exceptional ability to make good decisions in accordance with WMY policies and procedures.
• Strong ability to positively function with internal and external customers in a medical billing office setting.
• Two years experience as a Medical Biller/Claims Examiner/Claims Analyst demonstrating the ability to bill using accurate coding and independently resolve claim problems through to payment.
• Working knowledge of medical terminology, CPT4 and ICD coding.
• Experience with claims billing software.

Skills

• Microsoft Office
• Excel
• Medical terminology
• CPT4 coding
• ICD coding
• Claims billing software
• Athena
• Denticon
• 10E11
• Bilingual

Experience Level

• Two years experience as a Medical Biller/Claims Examiner/Claims Analyst

Education Level

• High school diploma or GED

Salary/Compensations

• $23.54 hourly

Benefits

• Generous time off
• Affordable health, dental and vision insurance
• 401k with safe harbor employer match
• Tuition reimbursement
• Term life insurance
• Commuter benefits

About the Company

• Whitney Young Health (WYH) provides high quality healthcare that is affordable and accessible to our diverse community.

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other legally protected status.