Job description

(09-5027-059)

About FCHC:

Since 1976, Florida Community Health Centers, Inc. (FCHC) has been a health care leader in Florida. We provide comprehensive primary and specialty health care and patient support services through a network of Centers surrounding Lake Okeechobee and across Florida’s Treasure Coast. Our mission is to ensure that everyone in our communities has access to culturally competent, high-quality health care that they can afford. FCHC has locations in Clewiston, Moore Haven, Okeechobee, Fort Pierce, Port St. Lucie, Stuart, Indiantown, Pahokee and West Palm Beach. FCHC’s Corporate Office is centrally located in West Palm Beach, Florida. FCHC has multiple staff members who speak Spanish and Creole, and translation is available for other languages as needed. FCHC has created a “one-stop shop” for patients–providing Pediatric and Adult Primary Care, Dental, OB/GYN and Women’s Health, Infectious Disease, Behavioral Health, Pharmacy, chronic disease education and care management, referral assistance, benefit enrollment assistance and coordination, and telehealth services. Our patients benefit from a “medical home” model, where they may access our extensive array of health care clinicians and services in an atmosphere where they are treated with respect, care, and concern.

Mission

The Mission of Florida Community Health Centers, Inc. (FCHC) is to provide accessible, cost-effective, high-quality, comprehensive health care to all persons in our communities.

Vision

Florida Community Health Centers, Inc. (FCHC) will maintain strong leadership in, and advocate for, the provision of health care services.

FCHC will foster and promote collaborative relationships and will develop partnerships with local, state, and federal public health service agencies and the community in general, to enhance the quality of delivery systems for comprehensive health care. FCHC will be an employer of choice and will demonstrate excellence with a highly trained staff and governing board.

Values

FCHC values Integrity, Compassion, Commitment to serving others (external and internal to the organization), Innovation, Effectiveness (cost and outcome), Efficiency, being Mission-driven, Commitment to serving others internal to organization and Commitment to Excellence.

Primary Duties:

• Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
• Answer incoming calls from patients when scheduled to do so
• Process patient credit card payment
• Monitors open claims to ensure they are closed by last day of month close
• Responsible for working claim rejections in a timely manner
• Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, be able to reconcile to Athena
• Processes incoming EOBs to ensure timely insurance filing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
• Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts
• Responsible for reconciling transactions to ensure that payments are balanced
• Ensure patient/insurance correspondence and $0 EOBs are completed monthly prior to month end close
• Perform analysis of denied claims, make recommendations for preventing future denials
• Responsible for keeping current with changes in payer’s policies and procedures
• Researches outstanding balances and takes necessary collection action to resolve in a timely manner; recommends necessary demographic changes to patient accounts to insure future collections
• Researches assigned correspondence; takes necessary action to resolve requested information in a timely manner; establishes appropriate follow up, including but not limited to opening and following up on cases with EMR vendor
• Work directly with insurance companies, healthcare providers, and patients to get claims processed and paid in timely matter
• Reviews and appeals unpaid/denied claims
• Willing to process patient collections when presented with the opportunity to do so
• Participate in monthly Billing Analyst team meetings submit recommended agenda items to the Billing and Coding Administrator
• Supports SFS Program and ensures patient account accurately reflects SFS Policies
• Perform other related duties as required or assigned by the Billing and Coding Administrator
• Assist in answering patient and employee phone inquiries. Assist in problem solving third party issues
• Coordinate with Credentialing Clerk to ensure timely, accurate set up of providers for FCHC participating plans.
• Maintain 1500 medical/dental claim form inventory and window envelopes

Minimum Requirements (experience, training, and education): To effectively fulfill this position, candidate must meet the following requirements:

• Knowledge of submission and resubmission of medical claims
• Government and commercial policies and procedures knowledge.
• Knowledge of ICD, CPT codes and HCPCS coding
• HIPAA compliance rules and regulations
• Skill in the operation of billing software and office equipment
• Skill in processing claim denials efficiently and on a timely basis
• Superior interpersonal and problem-solving skills along with a high initiative to succeed

Additional Notes

This job description is not intended to be all-inclusive, and employee will also perform other reasonable related business duties as assigned by supervisor.

This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• West Palm Beach, FL: Reliably commute or planning to relocate before starting work (Required)

Experience:

• ICD-10: 1 year (Preferred)

Work Location: In person

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