The Role
Enter and verify patient and insurance billing data using the practice management system, confirm eligibilities, match charges to documentation and coding guidelines (CPT/CDT), manage reports (open encounters, aging, credit balance), post payments and EOBs, follow up on denied/delinquent claims via insurer portals, assist with Medicaid forms and audits, and provide cross-training and backup for related billing functions.
Summary Generated by Built In
Description
Basic Function: To accurately collect and input billing data into the computer system
Principal Accountabilities:
- Enter patient charges into the practice management system
- Ensure patient and insurance information accurately into the practice management system
- Verify and obtain insurance eligibilities for all patient visits
- Verify billing charges with the chart note to make sure all charges match the coding guidelines and all procedures are billed correctly
- Communicate questions in a task to providers regarding documentation and/or billing charges
- Print and work Open Encounter Report daily
- Work Credit Balance report and Aging reports
- Be able to provide estimates, predeterminations and/or outreach
- Complete and send out Medicaid threshold forms
- Must be able to use the CPT and/or CDT coding book
- Act as a backup for the Dental Billing or Billing Representative-payment poster
- Reconcile and close receipts and charges to daily journal, computer generated reports to ensure accuracy
- Assist in the training of Dental or Billing staff
- Assist management in compiling necessary information for audits, both internal and those required by outside entities.
- Other duties and responsibilities as may be requested by supervisor and/or management
- Cross training for posting explanation of benefits
- Post daily Time of Service, collection, slide, daily logs and/or incoming payments
- Contact insurance companies to follow up on delinquent claims
- Follow up on denied claims by sending claim status requests to appropriate insurance companies
- Process claims for service via websites of insurance companies.
*This position has the option to be hybrid, once training is completed.
Requirements
- High school graduate or GED
- Must have the ability to maintain the knowledge of coding guidelines
- Verbal and written communication skills, office applications preferred
- Demonstrate proper judgment and decision making skills
- Comply with the organizations code of conduct, safety rules and adheres to all company policies
- Must be willing to and demonstrate the ability to cooperate, work, and communicate with coworkers, supervisors, and visitors to our facility in an ethical, effective and professional manner
- Must demonstrate computer proficiency with Microsoft Suite and the practice management system
- Must possess the ability to display compassion and work well in stressful situations
- Must be keenly aware of the importance of confidentiality in all aspects of the position
- Upgrade to a higher level from Billing Rep. to Specialist to Senior would depend on length of employment, current work performance, how many insurances one is taking on and accuracy in completing in a timely fashion
Skills Required
- High school diploma or GED
- Proficiency with Microsoft Office
- Proficiency with practice management system
- Knowledge of CPT and/or CDT coding guidelines and ability to use coding books
- Ability to verify insurance eligibility and contact payers via insurer websites/portals
- Ability to post payments, reconcile receipts, and close daily journals
- Verbal and written communication skills
- Maintain confidentiality and follow code of conduct
- Judgment and decision-making skills; ability to work under stress and show compassion
- Willingness to cooperate and communicate with coworkers and supervisors
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The Company
What We Do
Northern Oswego County Health Services, Inc., operating as ConnextCare, provides comprehensive medical, dental, and behavioral health services to Oswego County residents, aiming to promote community wellness.







