JOB DESCRIPTION

Position: Medical Biller/Collections

Pay Range: $24.00-$27.00 PER HR

Reporting To: Reimbursement Manager

Work Type: Hybrid (4 days in office, 1 day remote)

POSITION SUMMARY:

The Medical Biller’s responsibilities include tasks that require data analysis and sound judgment to help our patients/clients throughout the billing process. In addition, the best candidate for this position will be experienced with billing software and medical insurance policies. The Medical Biller will work directly with the Reimbursement Manager to ensure that all daily and weekly responsibilities are completed within a timely manner.

QUALIFICATIONS:

1. High school diploma or GED preferred.
2. 3 years+ of prior medical billing experience.
3. Effective communication skills.
4. Ability to organize details logically and accurately.
5. Ability to work independently and be result oriented.
6. Effective interpersonal skills, including the ability to promote teamwork.
7. Strong problem-solving skills.
8. Excellent PC operating skills and use of MS Excel.

ESSNENTIAL DUTIES AND RESPONSIBILITIES:

The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.

1. Responsible for charge and payment entry within Companies EMR. Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/ claim adjudication.
2. Responsible for correcting, completing, and processing claims for all payer codes.
3. Analyze and interpret claims and ensure that they are accurately sent to insurance companies.
4. Perform follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts.
5. Answer/respond to correspondence related to patient accounts. Is available to answer billing and changes related inquiries by patients, staff, Managed Care Organization, etc.
6. Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
7. Independently write professional appeal letters
8. Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
9. Identify denial patterns and escalate to Management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
10. Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to Management as appropriate.
11. Other duties as assigned.

PHYSICAL REQUIREMENTS:

• Stand, sit, talk, hear, reach, stoop, kneel and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis (up to 75% of the time).
• Close vision requirements due to computer work.
• Light to moderate lifting may be required (up to 25lbs).