The incumbent in this position manages a team of nurses and/or medical assistants. He or she reports directly to the Director of Nursing while working collaboratively with members of Senior Leadership, Providers and other staff to provide quality primary care to persons living across North Alabama.

Duties and Responsibilities

• Provide direct supervision to clinical support staff to ensure that all triage management, referrals to external providers, completion of physician orders, documentation of findings, and creation of a mutually developed plan of patient care, clinical coverage and in-office procedures (time sheets and PTO requests) are carried out in an appropriate and efficient manner.
• Oversee and coordinate all day-to-day patient care activities and operations and identify opportunities for improvement in conjunction with advice from Director of Nursing.
• Manage and coordinate clinical services adhering to federal guidelines, state guidelines, clinical standards and funding requirements.
• Provide supervision for clinical staff during extended clinic hours on a rotating schedule.
• Collaborate with assigned clinical staff to maintain the in-house 340b medication orders and inventory to ensure the resources are allocated appropriately.
• Serve as a backup to employee health nurse to ensure that staff participates in the employee health program (i.e., infection control), including exposure control plans, annual screenings and vaccinations.
• Serve as backup for clinical support staff when needed
• Assist with hiring clinic support staff.
• Train and supervise assigned clinical staff to include orientation, work allocation, and problem resolution.
• Ensure nurses and medical assistants adhere to all policies and procedures.
• Ensure compliance with Occupational Safety and Health Administration standards.
• Provide medical education to clinical support staff, as needed.
• In collaboration with the Director of Nursing, assist in developing and implementing all clinical policies and procedures.
• Precept students at Bachelor level or below
• Conduct performance evaluations and develop annual goals and measurable objectives for your assigned clinic staff.
• Maintain active CPR certification.
• Complete all other tasks and duties as assigned.

Knowledge, Skills, and Abilities

• Knowledge of concepts and principles of infectious disease in adult patients living with HIV.
• Knowledge of concepts and principles of primary care
• Knowledge of concepts and principles of sexually transmitted diseases
• Knowledge of concepts and principles of pediatric care
• Knowledge of clinical policies and procedures.
• Knowledge of electronic medical records systems.
• Knowledge of Excel, Microsoft Office and other database use.
• Knowledge of HIPAA laws and commitment to protecting the privacy and confidentiality of our patients.
• Ability to prioritize needs and plan work assignments accordingly.
• Ability to communicate effectively and maintain working relationships with people from diverse ethno-cultural backgrounds.
• Ability to lift and carry a minimum of 30 pounds, sit for extended periods of time, and walk between office buildings.

Software Access

• Microsoft Office
• eClinical Works
• CAREWare

Minimum Qualifications

Licensure as a registered nurse in the State of Alabama and one of the following: (1) bachelor's degree in nursing (BSN) with three years of nursing management experience; or (2) an associate's degree in nursing (ADN) with five years of nursing management experience.

This position is considered a management position and requires a 4 week notice of resignation to qualify for full payment of accrued PTO up to 80 hours.

This position is responsible for directing and coordinating the overall day to day function of the medical and behavioral health billing and collection department to ensure maximization of cash flow and revenue realization.

Duties and Responsibilities:

• Supervise the operation of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
• Responsible for billing activities to proper carriers to include Medicaid, Medicare, and private insurances. This includes claim submission and follow-up, payment receipt and processing, communicating with patients about their responsibilities, co-pays and deductibles, and sliding fee schedule.
• Insurance reimbursement rates contract negotiation for all clinics.
• Plan and direct patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection.
• Review assigned diagnostic and procedural codes on all medical record types at an advanced level to ensure proper reimbursement and accurate database information prior to billing.
• Oversee provider chart locking.
• Perform provider insurance credentialing to the appropriate carriers.  
• Prepare and analyze accounts receivable reports, weekly and monthly financial reports, and insurance contracts. Collects and compiles accurate statistical reports.
• Develop working relationships with insurance companies, research issues as needed, staying abreast of changes with carrier rule and distribute the information within the agency.
• Develop billing policies and procedures and ensure the operations are conducted in a manner consistent with overall department protocol, compliant with Federal, State, and payer regulations, guidelines, and requirements.
• Monitor and utilize the Clearinghouse for claim submission and denials.
• Post and review reimbursements and EOBs to ensure payment is accurate and in agreement with charges.
• Manage denials, invalid claims, rejections and resubmissions, and assist in appeals as needed.
• Oversee monthly mailing of patient statements for charges not covered by insurance and work with patients to establish payment plan for past due accounts.
• Responsible for month-end closing.
• Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures.
• Reviews and interprets operational data to assess need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
• Assisting with the creation of Fee Schedules to be submitted to the Board of Directors for approval.
• Evaluate performance, make recommendations for training and problem resolution, motivating employees to achieve peak productivity and performance.
• Other duties as assigned.

Knowledge, Skills, and Abilities

• Ability to work under minimum supervision and demonstrate strong initiative.
• Ability to evaluate and solve problems, correct errors, and develop processes to eliminate redundancy.
• Ability to conceptualize work flow, develop plans, and implement appropriate actions.
• Knowledge of HIPAA confidentiality requirements, maintain strictest confidentiality.
• Knowledge of State and Federal Compliance Regulations for all Managed Care programs.
• Knowledge of EMR software, Excel, Word, and clearinghouse software.
• Knowledge of CPT, HCPCS, ICD-9, ICD-10 coding protocols, Medicaid, Medicare and third party billing and coding.
• Effectively communicate with physicians, patients, colleagues and staff.

Software Access

• Microsoft Office
• eClinialWorks

Minimum Qualifications

• Bachelor degree in a related field (i.e. Accounting, Medical Billing, Healthcare Administration) with minimum of five years Medical Insurance/Healthcare Billing and Collections experience preferred.
• Three years minimum supervisory experience.
• Completion of accredited medical records program i.e., Certified Coding Specialist, Certified Professional Coder or AAPC, Certified Professional Biller.
• Experience with revenue cycle management in any capacity for Federally Qualified Health Centers (FQHCs) is preferred.

Responsible for collecting, posting and managing account payments; responsible for submitting clean claims and following up with insurance companies.

Duties and Responsibilities:

• Prepares and submits clean claims to various insurance companies electronically (or by paper).
• Accurate data entry of patient demographic information, charge entry, posting receipts, adjustments and reserves in accordance with EOBs and patient checks.
• Reviews and processes payments verifying insurance companies are paying according to their fee schedules.
• Investigates and follows up on all outstanding accounts and works denials within 3 days of receiving.
• Processes appeals as needed.
• Recoupments from payers to be handled within 3 days.
• Notify management immediately upon the receipt of a RAC or payer audit.
• Has working knowledge of various insurance plans and collects co-pays and deductibles as indicated by third party payers.
• Evaluates records and prepares reports, on such topics as number of denied claims or documentation or coding issues, for review by management.
• Post all manual and electronic payments within 24 hours of receipt.
• Audit of EOB posting should have a 95% or higher correct posting rate.
• Maintain insurance payer buckets within MGMA standards for the agency.
• Communicates denials for coding and documentation to coders and management for review.    
• Interact appropriately with difficult patients in an attempt to resolve any questions regarding charges or payments.
• Understanding of computer system in order to assist patients with billing problems.
• Assist in other job duties related to front office.
• Participates in educational activities and attends routine staff meetings.
• Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
• Performs other duties as assigned by management.

Knowledge, Skills, and Abilities

• Knowledge of medical billing, coding, and business office procedures.
• Knowledge of computer programs and basic office equipment.
• Knowledge of Medicare reimbursement guidelines; and third-party operating procedures and       practices including comprehension of explanation of benefits (EOBs).
• Ability to research and analyze data, resolve issues. Must be multi-tasking, well organized, and detail-oriented.
• Ability to multitask, prioritize and meet deadlines.
• Excellent written and verbal communication skills.
• Maintain CEUs as necessary to maintain certification.

Software Access

• Microsoft Office
• eClinialWorks
• Acrobat Pro

Minimum Qualifications

A High School Diploma and two to four years’ experience in billing, reimbursement, and denial management. Completion of accredited certification insurance billing program AAPC /AHIMA is required or must be obtained within 1 year of employment. (CPB – Certified Professional Biller)

Duties and Responsibilities

• Coordinate outgoing medical referrals as ordered by the provider.
• Develop a knowledge base for all insurance plan coverage as it pertains to referrals, diagnostic imaging, radiology and special procedures.
• Schedule diagnostic imaging, radiology or special procedures as ordered by the provider.
• Communicate with patient on referral information, to include but not limited to time, place and special instructions regarding the referral, diagnostic imaging or procedure.
• Follow up with any open referrals and ensure medical records, diagnostic imaging results and procedure results are received back to the clinic in a timely manner.
• Document incoming referral notes and procedure results in the patient chart, ensure they are assigned to the provider accordingly.
• Ensure that referrals are in accordance with FQHC guidelines.
• Complete any medical or medication Prior Authorizations that are required by the insurance company.
• Review the provider schedule the day before and ensure any pending referrals, DI and procedures are addressed. Communicate any discrepancies or issues.
• Review the fax inbox daily, attach fax documents to the appropriate patients and direct fax documents to the appropriate staff.
• Participate in Team Meetings
• Participate in Quality Improvement projects as directed.
• Perform triage of patients with documentation to include, but not limited to, HPI, medication reconciliation, medical history, family history, social history, vital signs and preventive medicine, as needed.
• Administers medications, immunizations and therapeutic injections as ordered by the provider while following 340b and ADAP guidelines, as needed.
• Notify patient of lab results and diagnostic imaging results, as needed.
• Address any medication refill request, as needed.
• Input patient data into EClinicalWorks and Careware, as needed
• Other duties as assigned.

Knowledge, Skills, and Abilities

• Knowledge of HIPAA laws.
• Ability to work independently with minimum supervision.
• Basic computer literacy skills including but not limited to EMR, MS, Excel and CAREWare.
• Ability to work with patients, significant others and staff from diverse populations.
• Ability to effectively communicate with staff and patients.

Software Access

• Microsoft Office
• eClinical Works
• CAREWare

Minimum Qualifications

• Minimum of 2 years of experience as CMA, prior medical referral experience preferred
• Certification as a Medical Assistant or as a Certified Clinical Medical Assistant (CCMA) by the National Health Career Association (NAH).
• A Certificate, Diploma or Associates degree in Medical Assistant

Special Note: Every two years, successfully complete 10 C.E.U.s in medically related courses.

The incumbent in this position serves as a vital member of the healthcare team by utilizing phlebotomy skills to obtain samples from patients for analysis.

Duties and Responsibilities

• Obtain blood specimens by established venipuncture and capillary techniques (adult and pediatric), as well as urine or other samples as ordered by the clinician.
• Process, package, and route specimens to the appropriate laboratory while maintaining specimen integrity by approved laboratory methods.
• Run routine CLIA-waived in-office tests (e.g., urine pregnancy, strep A, influenza, urine dipstick).  Ensure Quality Control is performed and documented.  Troubleshoot if QC is out of acceptable range.
• Ensure safe handling of blood products and proper disposal of hazardous waste.
• Assist in compliance with OSHA standards and AAC policies and procedures for infection control by maintaining a clean and sterile environment, including daily cleaning of the lab and emptying of biohazard bags. 
• Maintain log book(s) for specimens sent each day.
• Receive and enter lab results into the patient's electronic medical record (EMR) and CAREWare.
• Maintain Temperature logs twice a day on the laboratory refrigerator, freezer and room temp.  Troubleshoot if temperatures are out of range.
• Inventory control of laboratory supplies.
• Review pending labs and investigate if any are missing.
• Report equipment or lab deviations to lab supervisor, take action to remediate.
• Collaborate with providers and Director of Nursing to discuss updates on clinical lab tests and specimen collection.
• Conducts investigation into receiving lab or collection discrepancies.  Presents resolutions to supervisor.
• Assist at ancillary sites as needed.
• Participate in Quality Improvement Project.
• Provide coverage at other Thrive Alabama facilities as needed.
• Maintain Phlebotomy certification
• All other duties as assigned. 

Knowledge, Skills, and Abilities

• Knowledge of basic concepts of HIV transmission, prevention and disease process.
• Knowledge of specific laboratory solutions, materials, and media necessary to perform duties.
• Knowledge of HIPAA confidentiality requirements and commitment to safeguarding client information.
• Basic computer literacy for data entry, including Microsoft Excel and EMRs.
• Ability to prioritize needs and plan work assignments accordingly.
• Ability to work with patients, significant others and family members from diverse populations.
• Ability to communicate effectively and maintain working relationships with others.
• Ability to lift and carry a minimum of 30 pounds, sit for extended periods of time, and walk between office buildings.

Software Access

• Microsoft Office
• eClinical Works
• CAREWare

Minimum Qualifications

• High school diploma and at least one (1) year of laboratory experience.
• Certification in Phlebotomy from an accredited college or technical school may substitute for the required experience.

Duties and Responsibilities

• Perform triage of patients with documentation to include, but not limited to, HPI, medication reconciliation, medical history, family history, social history, vital signs and preventive medicine.
• Administers medications, immunizations and therapeutic injections as ordered by the provider while following 340b and ADAP guidelines.
• Assist Provider(s) with examinations, refilling medications, reviewing lab results, in house procedures, facilitating referrals and prior authorizations with appropriate documentation.
• Review daily charts with providers to address patient preventive healthcare maintenance, immunization schedule, potential risk factors and CDSS alerts.
• Report any significant patient conditions or reactions to medications or procedures immediately to the provider or supervisor.
• Assist in the evaluation of patient encounters in regards to coding in the EMR for procedures to optimize billing.
• Notify patient of lab results, procedure results and referral appointments.
• Explain ordered procedures or treatments to patients.
• Assist SW staff with required refills for ADAP, PAP or Curant programs.
• Input patient data into EClinicalWorks and Careware.
• Sanitize and restock supplies used in exam rooms as needed.
• Set up AV equipment for Telemedicine and assist Provider(s) in seeing patients via Telemedicine.
• Participate in team meetings.
• Participate in Quality Improvement projects as directed by the Quality Manager.
• Other responsibilities assigned by Director of Nursing.

Knowledge, Skills, and Abilities

• Knowledge of HIPAA laws.
• Knowledge of HIV transmission, prevention and disease process
• Ability to work independently with minimum supervision.
• Basic computer literacy skills including but not limited to EMR, MS, Excel and CAREWare.
• Ability to work with patients, significant others and staff from diverse populations.
• Ability to effectively communicate with staff and patients.

Software Access

• Microsoft Office
•  eClinical Works
• CAREWare

Minimum Qualifications

Certification as a Medical Assistant or as a Certified Clinical Medical Assistant (CCMA) by the National Health Career Association (NAH). A Certificate, Diploma or Associates degree in Medical Assistant. Bilingual preferred.

Special Note: Every two years, successfully complete 10 C.E.U.s in medically related courses.