Responsible for developing and maintaining training programs for staff, specific to the Revenue Cycle within Organizational policies for continuous improvement of revenue recovery. Responsible for assisting the Credentialing Coordinator in insurance contracting, provider enrollment and credentialing for all CBHA licensed providers.

1. Responsible for training staff

2. Collaborates closely with the Billing Supervisor and claims management team to identify training needs

3. Assesses and identifies training needs specific to practice-site operations, specifically those that have an impact on revenue cycle

4. Administers group and one-on-one training for staff, managers and clinicians employed by the Organization monthly

5. Coordinates changes in insurance regulation, providing in-service to Billers and Patient Financial Service Representatives.

6. Attends monthly department meeting for Billing, Coding and Patient Service Representatives.

7. Responsible for Reimbursement Recovery support

• Investigates disallowed codes for reimbursement opportunity, as needed
• Assesses A/R rejections and denials, negative payer trends, and provide feedback to management for appropriate action, including training agenda material monthly
• Corresponds with third party payers who provide information necessary to assist in determining most appropriate reimbursement levels, as needed

8. Responsible to assist Billing department to support managing denial claims                    workflow as directed

• Researches denial claims received from payers weekly
• Follows-up with customers to ensure maximum payments are made
• Reviews outstanding insurance claims within designated alpha discipline or payer monthly
• Responsible to assist Billing department to support processing of payments to/from third- party vendors daily as directed
• Researches and resolves claim, payment and capitation issues
• Reviews claim payments reports
• Audits claim payment reports for accuracy and compliance
• Monitors charges and verifies correct payment of claims and capitation of deductions

9. Responsible for assisting with provider enrollment, insurance credentialing and contracting.

• Utilizes credentialing software to maintain current and accurate data for all providers
• Completes provider credentialing and re-credentialing applications with health insurance companies; monitors applications and follows-up as needed
• Maintains knowledge of current health plan and agency requirements for credentialing providers
• Ensures practice addresses are current with health plans, agencies and other entities
• Processes applications for appointment and reappointment of privileges in compliance with regulatory bodies (Joint Commission, NCQA, URAC, CMS, federal and state) as well as delegated contracts
• Audits health plan directories for current and accurate provider information 

10. Performs coding functions as appropriate, including assisting with coding backlogs as                    

11. Participates in the development and maintenance of Organizational policies and procedures related to but not limited to operations of the practice management system

12. Maintains appropriate level of knowledge of practice management software by continuous vendor training and third party education

13. Develops and maintains specific training materials associated with training programs for the practice management software

14. Promotes a positive work culture and upholds clinic policies and procedures, including the WE CARE standards of Behavior

15. Must uphold confidentiality at all times in regards to CBHA activities, reports, financials, patient health information and other proprietary information specific to CBHA

16. Other duties as assigned

General Development:

1. Demonstrates a high degree of organization and planning skills
2. Demonstrates ability to use independent judgment to manage and impart confidential information
3. Possesses skills in examining and re-engineering operations and procedures.
4. Ability to develop and implement new strategies and procedures
5. Ability to effectively communicate with and train, Patient Services Representatives, physicians, management and staff

Professional and Technical Knowledge:

1. Possesses general work-related skills at a higher level than completion of high school, including written and verbal communications skills, computational and computer skills, and mathematical knowledge frequently acquired through completion of a "business school (non BA/BS)" or "associates degree" type program
2. Minimum of five (5) years’ experience in medical office/billing services
3. Possesses knowledge of organization structure, workflow and operating procedures within a Community Health Center billing environment

Technical Skills:

1. Ability to prepare basic correspondence and simple reports in Microsoft Word
2. Ability to prepare basic Microsoft Excel tables and simple displays of information
3. Ability to prepare and interpret financial and statistical reports
4. Ability to create basic presentations in Microsoft PowerPoint