Medical Billing and Accounting Professional

General Statement of Duties:

Performs a variety of moderately complex reimbursement and A/R tasks. The position requires exceptional attention to detail, intermediate spreadsheet and financial software skills, the capacity for handling a high volume workflow that may involve competing demands, and the ability to adapt to new work procedures and new situations, as well as maintaining consumer confidentiality.  The incumbent closely coordinates work assignments and responsibilities with the Controller.  This position reports to the Controller.

This position is classified non-exempt under the provision of the Fair Labor Standards Act.

Major Essential Functions:

Job duties will evolve and may change based on agency demands.

Performs and processes billing activity/transactions to insurance/third-party payers and CSB

consumers.  Maintains regular submission of electronic claims to designated payers.  May prepare and issue consumer statements, third-party invoices, and miscellaneous invoices.

Pursues unpaid/outstanding claims, delays, denials, or other problems in payment of designated

payers.  Identifies and resolves billing problems and account discrepancies.  Contacts third-party payers to verify eligibility, check claim status, and/or follow up on outstanding claims.

Applies consumer and third party payments, file insurance remittances, and prepare consumer

refunds for approval.  Helps manage unapplied cash account.

Maintains up-to-date knowledge of third-party and other payers’ requirements in order to assist with

notifications within the electronic health record and maximize reimbursements from those

sources of revenue.

Serves as the primary back up to the Reimbursement Liaison position for financial intakes at Main

Street, Arbor House, and McNulty Center.

Assists in the collection procedures of consumer overdue accounts (legal action, set-off debt).

May prepare and send necessary paperwork to maintain CSB information with the state Set-Off Debt

(SOD) Collection program, including processing Add, Change, and Update Forms.  May transmit SOD file to VA Dept. of Taxation and reconcile CSB SOD list with State SOD list.  After match, may send official taxation letter and CSB discount offer letter to consumer.

May prepare various reports, including insurance exception reports, Medicaid spend-down

information for on-site Department of Social Services Worker, and APR and SPO data.

Maintains effective relationships with co-workers and consumers based on courtesy, compassion,

and respect.

May back up other departmental functions or perform other duties and special projects as assigned, consistent with established operational policies and procedures.

Required Knowledge, Skills and Abilities:

Technical knowledge of accounts receivable and medical billing practices with emphasis on managed care and third-party payments; excellent knowledge of office procedures and equipment; intermediate knowledge of Excel and demonstrated knowledge of computer operations; flexibility with work duties; ability to work independently, but coordinate responsibilities and assignments with the work of others; ability to perform detailed, accurate work; ability to understand and follow oral and written directions; ability to communicate effectively, verbally and in writing; excellent interpersonal skills; ability to use good judgment and exercise tact; ability to explain complex payment/billing issues in an understandable manner; ability to make decisions and initiate action based on established policies and procedures; ability to seek and use supervision appropriately; dependability; ability to work as a team member, within the department and the agency; and ability to maintain confidentiality.

Minimum Educational Experience:

Completion of high school or GED, preferably supplemented by college or business school courses; plus two years progressively responsible experience in relevant administrative support work, including reimbursement and third-party billing experience, OR any equivalent combination of training, experience, and aptitude that provides the required knowledge, skills and abilities.

Other Information:

Equipment: PC and designated software, adding machine/calculator, copy machine, fax machine, printer, document scanner, and telephone system.

Work Environment: General office environment with normal lighting levels, temperature ranges, air quality, ventilation, and noise levels.

Work Location: North Main Street Campus, Harrisonburg, VA

Work Hazards: Some hazard associated with repetitive motion necessary for data entry/ typing; standard hazards associated with human services environment.

Work Schedule: Monday through Friday, regular office hours; some evening hours as scheduled; additional hours as needed to perform job requirements.  Regular attendance is required.  This position is required to take at least five consecutive days of leave each year.