Medical Biller

Job Scope

The Medical Biller is responsible for pursuing collection of all receivables from third-party and governmental payers.

Essential Duties And Responsibilities

• Continual follow-up on outstanding accounts through contracts/inquiries to third-party and governmental payers to facilitate prompt resolution or payment based on the Follow-Up department guidelines.
• Sort, prioritize, document receipt of insurance/patient correspondence, respond by initiating appropriate collection activity, and maintain filing of correspondence for future retrieval.
• Prepare and post any necessary adjustments/claim changes on accounts through the system based on the follow-up to expedite the collection process and to ensure the accuracy of the account daily.
• Confer with payers to determine the reason for unpaid balances and to obtain payment commitments.
• Review assigned accounts, process the debit/credit adjustments, rebill the account to payers and systematically move monies back to the insurance or patient bucket and appropriate next action.
• Analyze and calculate the payment and contractual amounts on remittances received from payers. Includes denied claims to ensure that patients are billed appropriately.
• Request refunds or retractions as appropriate.
• Pull medical record or request medical record from Health Information Management for suspended claims in a timely manner.

Qualifications And Requirements

• At least 1 year of experience in Hospital Billing, Follow-Up or Collections.
• A good understanding of reimbursement methodologies and terms.
• A good understanding of commercial & government payer billing requirements.
• A demonstrated knowledge of industry trends in Managed Care.
• Familiarity working with third-party contracts and payment rules.
• A demonstrated expertise in insurance, managed care and federal/state coverage.
• A high level of problem-solving skills.
• The ability to work independently, identify patterns, make informed decisions, correctly identify root causes to determine appropriate actions and outcomes.
• The ability to ensure the confidentiality and rights of patients and the rights of patients and the confidentiality of hospital and departmental documents.
• A working knowledge of personal computers and other standard office equipment.
• A positive demeanor, good verbal and written communication skills and being professional in both appearance and approach.
• The ability to handle potentially stressful situations and multiple tasks simultaneously.