Job Description:
Responsible for the billing and collections of physician claims. This position will file physician claims for reimbursement, including electronic and paper submissions. Monitor physician systems, billing and patient accounting system, department reports, taking corrective action to ensure accuracy in claim filing to payers. The Ambulatory Coordinator I will function in accordance with federal, state, and local laws; rules and regulations; and policies, procedures and guidelines of the employing health care institution or practice setting. This position is also responsible for consistent commercial insurance follow-up of physician claim(s) greater than 30 days, aged from final bill date, and resolution of same in a timely and cost-effective manner. This requires forming relationships with the individual insurance payers/clients in order to have the maximum response for timely and accurate payment. Monitor patient accounts assigned for accurate payment(s) or non-payment and take compliant actions for account reimbursement.

EDUCATION AND EXPERIENCE

• High School Graduate or Equivalent
• Two (2) years billing or coding experience preferred

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Resolution of all billing claims; electronic and manual. End of month reporting and distribution of reports to contracted physicians.
• Able to understand, explain and handle referral/authorization issues, pre-authorization requirements, verifications, appeals, and medical necessity issues.
• Timely follow up of claims including the completion of additional tasks to assure claims are paid timely. Ability to respond timely to insurance and billing inquiries made in person, by mail or over the phone. Completion of all billing edits
• Awareness, knowledge and cognitive ability in use of 1500 form locators, ICD 9 codes, CPT codes, and modifiers

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits