Billing Group Analyst Westchester ILBookmark This
Fresenius Medical Care
PURPOSE AND SCOPE:
Under general supervision, provides analytical support and guidance at the Business Unit and/or Billing Group level for functions related to the data integrity and operations of the FMS medical billing systems including but not limited to receivable financial reporting. Provides direction, advice and expertise to Business Unit and/or Billing Group personnel acting as a medical billing/healthcare receivable subject matter expert.
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
DUTIES / ACTIVITIES:
- Responsible for driving the FMS culture though values and customer service standards.
- Accountable for outstanding customer service to all external and internal customers.
- Develops and maintains effective relationships through effective and timely communication.
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
PRINCIPAL RESPONSIBILITIES AND DUTIES
- Provides data and analysis necessary to coordinate, facilitate, analyze and manage the successful completion of all accounts receivable functions which may also include providing recommendations for development of system enhancements to maximize efficiencies.
- Manages daily updates as well as all major system updates, provider number updates, and the corresponding employee education and training regarding those updates.
- Generates, prepares, analyzes and distributes daily, weekly and monthly reports as defined by management. Including but not limited to Aging, Payer Mix, Contractual Adjustment, Cash, Collection and Void Reports.
- Ensures reports are accurate, complete, and conform to FMCNA reporting and procedural standards.
- Assists the Director of Reimbursement and others in understanding overall AR performance including payor trending and analysis, acting as a reference point to the department on all system issues.
- Prepares analyses of accounts receivable data, evaluates outstanding accounts receivable, identifies trends, and then makes recommendations to Director of Reimbursement for areas of improvement.
- Responsible for any accounts receivable related research including but not limited to revenue, credit balances, allowances and reserves.
- Performs audits as defined by management, including but not limited to payer contract requirements, review of payer remittances, fee schedules, claim centers, and adherence to FMS policy and procedures.
- Manages billing system updates, including but not limited to:
-Daily, monthly, quarterly procedure pricing and coding, claim center and contract updates as needed.
-Maintaining all insurance files including but not limited to new carrier code request, contract modifications, formatting and setup of new insurances.
-Documentation and maintenance of records and serving as a reference for all system and billing related changes.
- Maintains TIN, NPI and Provider Number records for all assigned facilities.
- Completes and maintains records for all EDI, EFT, and ERA enrollment paperwork for all payers.
- Maintains payer set up and relationships with electronic websites and clearinghouses. Resolves issues that prevent claims from being transmitted via clearinghouses.
- Researches and resolves all billing system related issues.
- Maintains all systems’ user access records; requests new user access and changes as needed. (I.e., billing system, EDI system, Clearinghouses, ViaTrack, etc.)
- Monitors all billing and system related change requests/updates, and Corporate notifications; identifies and communicates impact on departmental process.
- Ensures compliance in meeting the Sarbanes-Oxley controls and requirements.
- Other duties as assigned.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Bachelor’s degree or 5+ years directly related AR/Accounting experience in lieu of degree.
EXPERIENCE AND REQUIRED SKILLS:
- 3 to 5 years Healthcare Receivable / Medical Billing experience.
- Working knowledge of Windows-based software applications (i.e. Outlook, Word, Excel, Access).
- Fundamental knowledge of revenue and general accounting cycle and principles.
- Current knowledge of accounting practices and issuesincluding, but not limited to:
-Revenues and accounts receivable,
-Medical Terminology, ICD-9, HCPC and CPT coding,
-Medicare, Medicaid and Commercial Insurance regulations,
-Federal and State regulations relating to medical billing,
-Electronic Claims Submission, Electronic Remittance Advices and overall AR systems.
- Ability to analyze data.
- Excellent written and verbal communication skills.
- Good interpersonal skills.
- Well organized and detail oriented.
- Positive attitude, enthusiastic and energetic.
- Ability to manage short and long-term projects.
- Ability to work independently with minimal supervision.