Billing Specialist and Account Representative – Family Medicine - AdventHealth Family Medicine Rural Health Clinics
Location Address: 187 PR 4060, Lampasas, TX 76550
Top Reasons to Work At AdventHealth Family Medicine Rural Health Clinics, Lampasas, TX
Part of AdventHealth to provide network of high-quality healthcare. Our care for patients extend to the spiritual level by praying with patients and families and providing on call, 24 hours, 7 days a week Chaplains for spiritual support.
Award winning facility with opportunities to grow both professionally and personally working with great individuals, part of a bigger team that continues to build a world-class culture where you become family.
Extraordinary benefits to include tuition reimbursement and on-campus classes.
Cost of living is 20 percent lower than the national average
Lampasas is northern gateway to the Texas Hill Country. 30 minutes from Fort Hood and about an hour out of the state capital, Austin.
Miles of scenic trails and parks available for recreational activity
Full Time - Days
You Will Be Responsible For:
Thoroughly researches reasons for denied claims as assigned to resolve outstanding balances
Prepares appeals, performs write off actions or assigns financial responsibility to next party in accordance with company policy.
Documents clearly and concisely claims adjudication
Processes and submits appeals in accordance with payer policy
Runs batch reports to ensure claims were correctly processed
Acts upon payer correspondence in a timely manner
Maintains hard copy files or electronic files of claim processing, authorizations, benefit parameters, and fee schedules rules and matrices
Follows up with insurance carriers on problem payments and adjustments.
Utilizes payer and clearinghouse web-sites for claims status or eligibility.
Clearly and accurately documents issues, sources and actions taken to describe activities and results.
For eligibility-related denials forwards requests to front desk for eligibility verification and updates
Adds a termination date to patient coverage when claim is denied “coverage termed.”
Identifies potential system problems and claims training issues discovered during review of claims/appeals and refers for resolution to the supervisor
Identifies and documents new payer denial trends, and notifies Team Leader for escalated follow up.
Escalates unresolved claim denials to supervisor for follow up with health plan provider representatives.
Post hospital and clinical charges
Post charges monthly for MD providers
Gathers Physician Oversight Home Health Recertification orders/paperwork and post every 60 days
Update a daily ticket report: unresolved patient encounters, unassigned patient charts, care plan oversight-e-prescribe, provider attendance, daily charges and daily payments
Process end of day batches and run reports at the beginning of each business day
Run End of Month reports at the end of each closing and End of Year reports
Able to meet Front Desk performance standards in Patient Appointments, Patient Registration, Insurance Verification, Payment and Charge Posting, etc,
Keeps complete, accessible and dated files
Verifies insurance eligibility and sets up accounts for new patients and Industries
Embrace and embody the mission, vision, values, and strategic plan of FMC
Responds professionally and effectively to questions from external sources (patients & health plan reps), & internal sources (providers & clinic staff)
Follows rules and regulations of Family Medicine Clinic as described in the FMC Employee Handbook and in the unit/department/clinic procedures
Follows policies and procedures in the FMC Rural Health Clinic Manual and Patient Care Policies
What You Will Need:
High school diploma or equivalent with at least 2 years medical billing experience
A non-exempt position responsible for performing all medical billing, communication with patients, insurance and vendors.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.