The Billing Coordinator reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Billing Coordinator owns benefits investigation/ verification, prior authorization, denial/appeal management, letters of medical necessity, and HOD vs. office-of-service site coordination; the dedicated payer-facing work. The Billing Coordinator is responsible for processing charges, payments and/or adjustments for all services rendered at all NM Corporate Health Clinics. Researches and follows- up on all outstanding accounts. Answers all calls regarding charges and claims, providing exceptional customer service to all callers. Possesses extensive knowledge of coding, billing, insurance and collections procedures and coordinates the accounts receivable functions. Performs weekly claims, monthly late bills and patient statement runs and reviews accounts to be placed with an outside collection agency.
RESPONSIBILITIES:
Department Operations
- Ensures patient demographic and billing/insurance information is kept current in the computer application. Documents all patient and company contacts.
- Reviews daily clinic schedules and tracks receipt of documentation to assure completeness of charge capture.
- Ensures notes are is placed in systems, clearly identifying steps taken, according to established procedures.
- Works with patients/clients to establish payment plans according to predetermined procedures.
- Handles all incoming customer service calls in a professional and efficient manner. Provides exceptional service to all customers, guarantors, patients, internal and external contacts.
- Prepares itemized bill upon request; explains charges, payments and adjustments. Produces a clear and understandable statement to individuals on any outstanding account balance.
- Responsible for timely submission of accurate bills and invoices to clients, patients and insurance companies.
- Ensures timely posting of all charges, payments, denials and write-offs to the appropriate account, maintaining the highest level of quality for each transaction processed within 48 hours of receipt.
- Responsible for balancing each payment and adjustment batch with reconciliation report and bank account deposits after completion.
- Ensures compliant follow up procedures are followed, to third party payers regarding outstanding accounts receivables.
- Run outstanding A/R reports, follow-up on unpaid claims or balances with insurance companies, patients, and collection agency, as defined by department.
- Perform daily systematic review of accounts receivable to ensure all accounts ready to be worked are completed.
- Recommend accounts for contractual or administrative write-off and provide appropriate justification and documentation.
- Denials and appeals follow-up including root cause analysis to reduce/prevent future denials.
- Reviews, prepares and sends pre-collection letters as defined by department procedures.
- Identifies and sends accounts to outside collection agency.
- Prepares and distributes reports that are required by finance, accounting, and operations.
- Handles all work in an accurate and timely manner, consistently meets or exceeds productivity standards, quality standards, department goals and deadlines established by the team.
- Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
- Identify opportunities for process improvement and submit to management.
- Demonstrate proficient use of systems and execution of processes in all areas of responsibilities.
Communication and Teamwork
- Fosters and maintains positive relationships with the Corporate Health team, Human Resources, NM employees and physicians.
- Provides courteous and prompt customer service. Answers the telephone in a courteous professional manner, directs calls and takes messages as appropriate. Checks for messages and returns calls.
- Demonstrates teamwork by helping co-workers within and across departments. Communicates effectively with others, respects diverse opinions and styles, and acknowledges the assistance and contributions of others.
- Communicates appropriately and clearly to physicians, manager, nursing staff, front office staff, and employees. Maintains a good working relationship within the department. Organizes time and department schedule well. Demonstrates a positive attitude.
HOURS: Monday-Friday 8:00am-4:30pm or 8:30am-5:00pm. This position is Hybrid x2 day a week.
Service Excellence
- Displays a friendly, approachable, professional demeanor and appearance.
- Partners collaboratively with the functional areas across Northwestern Medicine in support of organizational and team objectives.
- Fosters the development and maintenance of a cohesive, high-energy, collaborative, and quality-focused team.
- Supports a “Safety Always” culture.
- Maintaining confidentiality of employee and/or patient information.
- Sensitive to time and budget constraints.
- Other duties as assigned.