Billing Associate

Description

Founded in 1866, The Floating Hospital (TFH), is one of the last remaining charity hospitals in New York City. Our commitment is the same as it was more than 160 years ago: unrestricted healthcare to all who walk through our doors, regardless of immigration and insurance status, or the ability to pay. The Floating Hospital welcomes individuals of all ages, from infants, school age children (5+), youth and adults. TFH is a Federally Qualified Health Center and the largest provider to homeless families living in family shelters and domestic violence safe houses throughout all five boroughs.

• Receives electronic coded claims for all Medical and Dental services rendered from all locations in the Practice Management

System.

• Review Accounts Receivable reports and provide feedback on a weekly basis to the billing supervisor and include common

trends that impact the revenue cycle such as coding or eligibility issues.

• Contact supervisor to escalate issues that require resolution by the PM Vendor

• Work closely with the supervisors to ensure denials are corrected and appealed as appropriate in a timely manner.

• Review the Athena worklist and Dentrix AR report for initial claims submission or denied claim.

• Handle follow-up and appeals with assigned payers for unpaid, denied, and underpaid claims.

• Contact payers directly and work with the supervisor to resolve issues.

• Determine the reasons for the denials, correct the issue, and resubmit the claims.

• Contact the payer for additional information about non-payment.

• Utilize the various insurance portals to obtain additional information for rebilling claims.

• Reviews and submits all billable claims to insurance payers, third-party payers, and self-pay services in Dentrix system.

• Prepare daily batches of claim submissions in the Dentrix system and review the clearinghouse batch report.

• Review Athena worklist queue daily and follow up on denied claims.

• Assist with the maintenance of the daily claim submission tracking log.

• Receives and properly posts all electronic and manual payments and adjustment from insurance companies and patients into Dentrix system.

• Reviews and sends patient statements in Dentrix coordinating with the Billing Manager prior to submission.

• Analyzes electronic and paper remittances received for Dental:

a. Determines reasons for claim denials and makes corrections for resubmission.

b. Determines managed care plan payment for Medicaid Wrap claim submission.

c. Determines reasons for other claim errors and reports to the Billing Manager for review.

• Reviews self-pay accounts for medical and dental and locate id numbers for billing and assist with the retroactive review and

billing for self-pay patients.

• Assists with billing claims project and appeal submission to the insurance companies.

• Sort and categorize incoming mail for delivery to the contacts at various sites.

• Maintains Athena correspondence dashboard.

• Reconciles Cash received in the Athena and Dentrix system.

• Prepares deposit for cash and check received.

• Retrieves/obtains capitation rosters from the various insurance companies and updates the capitation file on the shared drive.

• Retrieves/obtains PCMH rosters from the various insurance companies and updates the file on the shared drive.

• Retrieves/obtains per member per month rosters from the various insurance companies and update the files on the shared

drive for UDS and MCVR reporting.

• Maintains the unpotable dashboard in Athena.

• Maintains the Unapplied credit dashboard in Athena.

• Processes Credit card payments and HIM Receipts.

• Processes patient refunds.

• Maintain a current knowledge of payer guidelines including Medicaid, Medicare, and Third Party.

• Maintain a system knowledge of the practice management systems – Dentrix and Athena.

• Attends meetings and training with the approval of the Supervisors.

• Complete special projects and report findings to management.

• Must comply with all HIPAA laws regarding electronic health records and patient information.

• Any other duties as assigned.

This is a Hybrid position.

Requirements

The Billing Associate position requires two to five years of experience in the medical billing environment. Some college backgrounds in health care or a financial field are highly recommended. The Associate must be familiar with medical and coding terminology and have excellent analytical and meticulous organizational skills. The candidate must possess strong skills in MS Office, MS Excel, and use of the various insurance portals. Must have experience working with Athena Practice Management System. Must be able to work effectively in a remote environment.