AR/Contracting Coordinator

JOB SUMMARY
The Contracts/AR Coordinator is a key position in the Revenue Cycle, manages aging reports, timely claim review of accounts receivables. Initiate contact with various Health plans, follow-up and correspondence with providers, health plans inquiries/correspondence.

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Knowledge of :

·         Contracting PPO

·         Health plan contracting policies.

·         ICD-10, HCPCS and CPT coding

·         Federal and state healthcare mandates and regulations

·         Company policies and procedures

·         Microsoft office applications and spreadsheets

·         General front office procedures and skills

·         Office machines; facsimile, copier, scanner, computer programs

·         Electronic Medical Records/EHR systems

Ability to:

Problem-solve

Prioritize with excellent organizational skills, responding to multiple demands and timeliness

Demonstrate professional written and verbal communication skills and presentation skills using the English language

Demonstrate ability to respond to common inquiries from patients, customers, vendors, regulatory agencies, health plans or member of the business community and possess excellent customer service skills

Twist, turn and utilize reaching motion, ability to sit and/or stand for extended periods of time

EDUCATION and/or EXPERIENCE

High school diploma and one (1) year related experience and/or training; or equivalent combination of education and experience.

2 years of medical billing

CERTIFICATES, LICENSES, REGISTRATIONS

None.

SKILLS
Able to work independently.  Has knowledge of industry standards and expectations.  Has knowledge of commonly used concepts, practices and procedures within this field.  Excellent verbal and written skills.  Computer literate with knowledge of Excel/Word.  Relies on experience and judgment to plan and accomplish goals.  Performs a variety of tasks.  Able to verify a variety of standard and/or complex patient data.  Knowledge of medical terminology preferred.  Excellent telephone skills. Able to verify a variety of standard and/or complex coded or un-coded statistical source data.  Knowledge of medical terminology and ICD9/ICD-10 codes.  Able to type 40+ words per minute.

·         Contracting efforts will be based primarily upon client nominations

·         Negotiate managed care PPO contracts, ensuring a cost-effective contract in compliance with all State, provider, and corporate requirements

·         Negotiate PPO contracts with independent hospitals and health care systems

·         Analyze data to develop strategies for contracting and re-contracting

·         Call/email medical providers for contracting

·         Develop and maintain relationships with key medical providers at the direction of the Director of Network Development

·         Enter all progress reports and any notations regarding contracting efforts into Prime’s proprietary database

·         Must be able to foster a positive and productive work environment.

·         Ensure that charges for services provided are accurately billed to the appropriate insurance companies via electronic and paper claim submissions.

·         Identifying and billing secondary or tertiary insurances.

Review referrals and pre-authorizations as required for procedures.
Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
Extract information from medical records, operative notes, hospital admissions, consults, progress notes and discharges to ensure completeness and accuracy
Reviews accounts receivable to maximize collections including and resubmitting previously denied claims.
Accurately reviews and resolves assigned claim and clearinghouse edits and payer rejections to minimize lag days.
Bill new claims and confirm proper submission of claims while maintaining claim filing reports and filing procedures
Ensure denied claims are evaluated, analyzed, appealed, and resubmitted with sufficient support to receive the maximum allowable payment amount
Review insurance payments to ensure proper reimbursements according to contracted rates
Ensure applicable out of pocket maximums, deductibles and/or co-pays are properly applied to patient accounts
·         Entering patient demographics and insurance information

·         Follow-up on electronic claims and paper claims

·         Refund money owed to patient or insurances

·         Conducts self in a manner that reflects a positive representation of the company and encourages others to do the same.

·         Observes strict patient confidentiality in dealing with patients.

·         All other duties as assigned

·         REQUIREMENTS:

Two (2) years of experience in medical billing or medical billing-related field
Strong knowledge of medical claim billing and insurances including but not limited to: Medicare, HMO, Workers Compensation, Blue Cross / Blue Shield PPO Plans, and more.
Excellent oral and written communication skills
Proactive and passionate about collecting
Well-organized, strong attention to detail, and effective multitasking skills
Ability to work as part of a team
Previous EMR experience
ICD-9 and ICD-10
HCPCS
Billing process and regulations
LANGUAGE SKILLS

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or government regulations.  Ability to write reports, business correspondence, and procedures manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

MATHEMATICAL SKILLS

Ability to perform basic mathematical calculations. Add, subtract, multiply, divide.

REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variable in situations where only limited standardization exists.  Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form

As an Equal opportunity employer, DBA Choice Medical Group is committed to a diverse workforce.  Employment decisions regarding recruitment and selection will be made without discrimination based on race, color, religion, national origin gender, age sexual orientation, physical or mental disability, genetic information or characteristic, gender identity, and expression,  veteran status, or other non-job related characteristics or other prohibited grounds specified in applicable federal, state and local laws.  In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans’ Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact this post for assistance.

For more information about equal employment opportunity protections, please view the ‘EEO is the Law’ poster.

NOTICE: EMPLOYEE POLYGRAPH PROTECTION ACT
YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT

PAY TRANSPARENCY NONDISCRIMINATION PROVISION

Our environment respects individual differences and recognizes each employee as an integral member of our company. Our workforce reflects these values and celebrates the individuals who make up our growing team.

Choice Medical Group provides a work environment free of harassment and prohibited conduct. We promote and support individual differences and diversity of thoughts and opinion.