Job Description

Job Description

Job Description

Dental BillerPittsburgh, PA 15218

Metro Community Health Center extends great benefits to our eligible employees .

MCHC current benefits are:

• MCHC pays 100% of the employee premium for UPMC Medical, United Concordia dental, STD, LTD
• Life insurance ($100,000)
• VBA vision coverage is offered as voluntary coverage that paid for by the employee
• Medical and Dependent Care FSA and HRA
• 2 weeks of paid parental leave
• 20 days (4 weeks) of PTO for your 1st two years
• 12 paid holidays
• 401k with a 4% match
• Competitive Wages

ESSENTIAL FUNCTIONS:

• Responsible for daily billing operations to ensure maximum productivity, accuracy of claims submission and third party follow up through automated work queues while assisting with resolution of disputed claims.
• Maintains a good working knowledge of the specific billing requirements for all payers for FQHC.
• Including assigning appropriate DPT-4 codes and appropriate ICD- 10-CM diagnosis codes selecting the codes that accurately describe the condition for which the service or procedure was performed.
• Provides ongoing training and development of staff as required to ensure payor requirements are met.
• Review claims editing reports for consistent errors and follow up with the management for improvement in quality and performance.
• Analyze and trend billing issues related to A/R, i.e., Specialty, Payer, Provider, etc. for efficiencies while taking proactive approach to resolve A/R issues prior to escalation.
• Engage in open communication with management regarding information system, third party payor, and regulatory updates and/or enhancements.
• Contacts patients to obtain, verify, and update account information when necessary
• Work with the payors and subscribers to resolve issues and facilitate prompt payment of claims.
• Develop and analyze reports that will monitor claim edit trends
• Ability to work independently, with minimal supervision. Must be very reliable and punctual as attendance is important for this position
• Participate in review and evaluation of claim denials to ensure appropriate reimbursement.
• Participate in assessing claim edits to enhance the billing system functionality and identify user training and development needs.
• Process monthly patient statements and answer patient inquiries in regard to those statements.
• Generate patient service invoices in a timely manner.
• Being familiar with the responsibilities of Patient Access and willing to perform such duties on a daily basis up to but not limited to answering patient calls, scheduling, insurance verification and prior authorizations.
• The list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities that management may deem necessary from time to time.

POSITION REQUIREMENTS

• High school graduate or equivalent, bachelor's degree preferred.
• Must be knowledgeable of medical and dental terminology, electronic and manual claims processing, and third-party payor billing guidelines and reimbursement practices for primary care centers.
• Must be able to establish priorities, effectively problem solve, and use good judgment and decision making in day-to-day billing operations and work independently.
• Must have ability to communicate well both orally and in writing. Requires prior working experience on personal computers and various office equipment.

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