Job Summary

Submits healthcare claims accurately and efficiently, including researching and correcting denials and errors, applying discounts and adjustments, and resubmitting claims as needed to ensure timely payment.

Responsibilities and Duties

1. Performs billing and collection activities for medical, behavioral health and dental services.
   1. Creates claims submissions for assigned payers and/or patient accounts.
   2. Corrects and resubmits rejected claims for assigned payers and/or patient accounts.
   3. Researches, corrects and resubmits denied claims for assigned payers and/or patient accounts.
   4. Follows-up with payers via the most effective channel (payer portals, email, phone) to resolve outstanding claims including filing appeals and reconsideration requests.
   5. Identifies credit balances for assigned payers and/or patient accounts, researches and verifies accuracy of credit balance and submits refund requests as appropriate.
   6. Identifies account balances meeting the criteria for bad debt write-off, researches and verifies accuracy of balance and flags balances as appropriate to be written off as bad debt.
   7. Posts third party payments for assigned payers and/or patient accounts accurately to charges.
   8. Reviews account balances for patients qualified for the Sliding Fee Discount Program and applies discounts to eligible patient charges.
   9. Performs work in accordance with departmental timelines for claims creation, submission, resolution of claim rejections and denials and open/unpaid claims.
   10. Assists with reconciliation of patient and payer payments as requested.
   11. Communicates with credentialing staff and/or external credentialing vendor as needed to ensure necessary enrollments and/or updates are performed to mitigate claims denials.
   12. Maintains all documents relevant to daily billing functions in internal data repository, e.g. remittance advices, payer correspondence, fee schedule, billing/coding rules, W9 forms, memos, charge slips, training documents etc.
2. Provides customer service to internal and external customers.
   1. Acknowledges, researches, and resolves patient inquiries related to billing and financial counseling functions.
   2. Provides written notification to supervisor of all patient complaints regarding billing and collections.
   3. Responds to staff inquiries regarding patient billing and collections.

Possesses specific knowledge and training in billing processes and practices, typically acquired during completion of a certificate program in billing practices with a duration of up to a year.  Possesses a basic knowledge of medical terminology, procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing and of insurance policies and contracts for multiple insurance vendors.  Current certification as a Community Health Coding and Billing Specialist (CH-CBS).

About Contentnea Health

Contentnea Health is a Federally Qualified Health Center (FQHC) with sites in Greene, Pitt and Pamlico counties in Eastern North Carolina. Our services include primary medical care, diabetic care, women’s health, mammograms, pharmacy, student health services, comprehensive dental care, integrated behavioral health care and case management. We are conveniently located between Raleigh, which offers the entertainment, activities and amenities of a larger city, and the beautiful towns and beaches along the coast.

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