Under the supervision of the Billing and Reporting Manager, reviews documentation of services provided to clients to ensure it is accurate and complete and prepares and submits billings for services provided. Ensures payments are posted within assigned program areas to appropriate accounts. Posts entries to patient management system for cash receipts and encounter entry, makes corrections to cash receipts and encounter entry, verifies and balances accounts receivable, balance revenue accounts to the patient management system.

1. Compiles, prints, reviews, corrects, and prepares bills to third party insurance companies, Medicare, and Medicaid programs. Keeps updated on all changes to insurances based on contracts, industry, or new regulations. Meet with insurance representatives and clinical staff to make necessary changes.

2. Receives and processes first and third party payments, posts to system, runs payment reports, and reconciles to payments received and entered. Reconciles Electronic Fund Transfers to Electronic Remittance Advices. Processes credit card payments. Combines miscellaneous payments received for grants and billings. Prepares spreadsheets, balances cash, and sends to accounting. Keeps cash box for making change and collecting payments.

3. Runs error and rejection reports by insurance carrier. Resolves data entry or billing problems. Works with staff to resolve and correct errors.

4. Reviews and prepares billing statement report for client balances. Sends report to 3rd party for printing and mailing statements. Prepares and sends statements and demand letters. Receives payments from clients and reviews disputed balances with clients using computer system and historical data.

5. Reviews, enters and accepts charges for all clinics and off-site services. Researches and reviews EHR/EDR charges or fee tickets and bills insurance carriers or other payers. Sends requests to providers for additional or missing information and provides instructions on necessary corrections. Runs weekly pending, unbilled and tasking reports to follow-up on discrepancies.

6. Serves as a resource to staff by answering questions regarding guidelines and limitations related to registration of third party insurances in the patient management system.

7. Responsible for record retention of the Billing and Reporting Unit. Prepares records to be transferred to off-site storage.

8. Responsible for review and billing of retroactive MIHP performed in the clinics and PHS. Initiates refunds, tracks services and performs follow-up. Tracks new prenatal clients to ensure correct billing.

9. Maintains reports on incentive, bonus and withhold payments from insurance companies.

Other Functions:
Performs other duties as assigned
During a public health emergency, the employee may be required to perform duties similar to but not limited to those in his/her job description.

(The above statements are intended to describe the general nature and level of work being performed by people assigned this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.)

Education: High school graduation or equivalent with specialized or technical training generally acquired through seminars, workshops, which cumulatively is viewed as equivalent to 12 credits or less of college. Certified Professional Coder (CPC) preferred.

Experience: One year of account keeping experience. Prefer experience with medical billing and computer software and equipment.

Other Requirements:

(The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.)

Physical Requirements:

• 
  Ability to access office files.
• Ability to enter and retrieve information from computer.
• Ability to access records and documents of the department.
• Ability to operate copy machines and other office equipment.
• Ability to stoop, kneel, and crouch to retrieve and put away supplies and materials.
• Ability to use a step stool to reach supplies.

• Works in office conditions.