Biller

Essential Duties of the Position

• Pull information needed to bill or assess status of insurance claim from client systems.
• Correctly read EOB’s to determine if insurances have paid in the proper order, and the correct amount of patient responsibility. Does additional billing need to take place?
• Ensure claim is entered in eHealth under correct provider name and address and provider identifying numbers.
• Hand key required field locators on UB-04 or CMS-1500 form in eHealth.
• Ensure accuracy of claim in eHealth or client billing system; run through appropriate HIPAA edits and correct claim errors as required.
• Bill claims using the clients billing system for certain clients and updating insurance properly in those system (see: P:\CBS\CBS FOLDER\Client System Work Instructions)
• Update FACS with note regarding billing of claim and move to appropriate follow-up status.
• Send paper claims with appropriate attachments to scanning.
• 2101 letters provided by work comp attorney
• Split among staff for billing to POEs.
• Bill and/or follow-up on Medicare accounts
• Check eligibility and correct claims in Med A.
• Advise the client of Medicare billing issues for specific accounts, i.e. the need for modifiers, lines that have denied for medical necessity.
• Use Med A or the Medicare IVR to determine the status of the claim.
• Determine patient responsibility after Medicare payment and move accounts to correct queues.
• In liability situations, determine what entity is responsible for payment of the claim.
• Bill and/or follow-up on Medicaid accounts
• As allowed by individual client access, submit claims via Indiana Medicaid web interchange.
• Check eligibility and claim status via Medicaid websites.
• Advise the client of Medicaid billing issues for specific accounts, i.e., the need for modifiers, lines that have denied for medical necessity.
• Determine patient responsibility after insurance payment and move accounts to correct queues.
• In liability situations, determine what entity is responsible for payment of the claim.
• eHealth Payer Reports
• review payer reports in eHealth for up front claim rejections
• Transmit electronic claims before 2:00 pm each day.
• Print and sort paper claims at the end of each day.

Responsibilities of the Position

• Filer limit accounts worked as assigned by manager
• Over 15 K accounts worked as assigned by manager
• WCP state file limit accounts worked as assigned by manager
• Urgent billing emails as assigned by manager
• Check eligibility
• Make calls to insurance companies to check eligibility and verify the claim submission
• Check eligibility on Passport and insurance websites.
• Accurately determine if the claim should be filed according to the eligibility status of the patient.
• Keep supervisor updated on significant issues that may be discovered in regards to certain payers or suggestions of how we can improve processes.
• Maintain deadlines for account review, completion of spreadsheets at the request of management.

Requirements

• Computer proficiency skills are required
• Ability to learn quickly and navigate effectively through multiple systems
• Excellent verbal and written communication skills
• Ability to work in fast-paced, changing environment
• Must be flexible and adaptive to change in order to support operations
• Demonstrates attention to detail and organization
• Must have the ability to perform repeated tasks with a high level of accuracy
• Must have working knowledge of HIPAA, FDCPA, and Red Flag regulations

Difficulty of Work

• Work activities are performed independently, utilizing basic guidelines as standards of performance.
• The incumbent must deal with a variety of reports, documents, and computer systems, and must utilize good judgment in carrying out job duties.
• Advice and guidance may be sought from the department’s Manager as warranted to ensure the provision of quality service.

Responsibility

• The incumbent works in a team concept, but will need to be able to work accounts on his/her own.
• Accounts are randomly checked for training purposes. Errors may be caught, but not immediately. Work is somewhat independent in nature.
• The incumbent makes a substantial impact on the processing of the account based on actions completed.

Personal Work Relationships

• Incumbent works with colleagues, team leads, supervisors and management staff.

Salary Description

$16 - 19 / hour