Billing Specialist - Account Representative - Copperas Cove at AdventHealth

Date Posted: 9/30/2021


Job Snapshot

  • Job Schedule
  • Date Posted:
  • Job ID:
  • Job Family
    Patient Financial Services
  • Shift
    1 - Day

Job Description


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

Work Hours/Shift:

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

Job Summary:

A non-exempt position responsible for performing all medical billing, communication with patients, insurance and vendors.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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