Description:
Founded in 1866, The Floating Hospital (TFH), is one of the last remaining charity hospitals in New York City. Our commitment is the same as it was more than 150 years ago: unrestricted healthcare to all who walk through our doors, regardless of immigration and insurance status, or the ability to pay. The Floating Hospital welcomes individuals of all ages, from infants, school age children (5+), youth and adults. TFH is a Federally Qualified Health Center and the largest provider to homeless families living in family shelters and domestic violence safe houses throughout all five boroughs.
Requirements:
- Receives electronic coded claims for all Medical and Dental services rendered from all locations in the Practice Management System.
- Review Accounts Receivable reports and provide feedback on a weekly basis to the supervisors of billing issues and common trends that impacts the revenue cycle such as
- Contact supervisor to escalate issues that require resolution by the PM Vendor
- Work closely with the supervisors to ensure denials are worked and appealed as appropriate in a timely manner.
- Review the Athena worklist and Dentrix AR report for initial claims submission or denied claim.
- Handle follow-up and appeals with assigned payers for unpaid, denied, and underpaid claims.
- Contact payers directly with the payers to identify and escalate problems and issues as needed.
- Determine the reasons for denials of billing and corrects information.
- Contact the payer for additional information for non-payment.
- Utilize the various insurance portals to obtain additional information for rebilling claims.
- Reviews and submits all billable claims to insurance payers, third-party payers, and self-pay services in Dentrix system.
- Prepares daily batches of claim submissions in the Dentrix system and review the clearinghouse batch report.
- Review Athena worklist queue daily and follow up on denied claims.
- Assist with the maintenance of the daily claims submission tracking log
- Receives and properly posts all electronic and manual payments and adjustment from insurance companies and patients into Dentrix system.
- Reviews and sends patient statements in Dentrix coordinating with the Billing Manager prior to submission.
- Analyzes electronic and paper remittances received for Dental:
a. Determines reasons for claim denials and makes corrections for resubmission.
b. Determines managed care plan payment for Medicaid Wrap claim submission.
c. Determines reasons for other claim errors and reports to the Billing Manager for review.
- Reviews self-pay accounts for medical and dental and locate id numbers for billing and assist with the retroactive review and billing for self-pay patients.
- Assists with billing claims project and appeal submission to the insurance companies.
- Sorts and categorizes incoming mail for delivery to the contacts at various sites.
- Maintains Athena correspondence dashboard.
- Reconciles Cash received in Athena and Dentrix system.
- Prepares deposit for cash and check received.
- Retrieves/obtains capitation rosters from the various insurance companies and update the capitation file on the shared drive.
- Retrieves/obtains PCMH rosters from the various insurance companies and update the capitation file on the shared drive.
- Retrieves/obtains per member per month rosters from the various insurance companies and update the files on the shared drive for UDS and MCVR reporting.
- Maintains the unpostable dashboard in Athena.
- Maintains the Unapplied credit dashboard in Athena.
- Processes Credit card payments and HIM Receipts .
- Processes patient refunds.
- Maintain a current knowledge of payer guidelines including Medicaid, Medicare, and Third Party .
- Maintain a system knowledge of the practice management systems – Dentrix and Athena .
- Attends meetings and training with the approval of the Supervisors.
- Complete special projects and report findings to management.
- Must comply with all HIPAA laws regarding electronic health records and patient information.
- Any other duties as assigned.
ASSIGNMENT, REVIEW, AND APPROVAL OF WORK:
The Billing Associate will also perform other analytical projects related to the patient services database as needed by the Billing Manager & Director of Revenue. Cycle.
BACKGROUND AND EDUCATION:
The Billing Associate position requires two to five years of experience in the medical billing environment. Some college background in a health care or a financial field is recommended. The Associate must be familiar with medical and coding terminology and have excellent analytical and detail-oriented organizational skills. Strong skills in, MS Office, MS Excel and insurance portals are required.
This is a Hybrid position.