JOB SUMMARY
The Biller is responsible for the facilitation of accurate and timely claim processing in accordance with laws, regulations, and administrative rulings of governmental organizations, other regulatory agencies, and contractual obligations. They are responsible for accurate and timely posting of account adjustments. The representative will also be follow up with all 3rd party payers for resolution of all outstanding accounts.
PRIMARY JOB RESPONSIBILITIES
- Bill claims accurately and in a timely manner.
- Initiate process improvement as needed based on billing edits.
- Demonstrate account review techniques that support validating the UB.
- Identify appropriate external and internal resources to resolve missing or incorrect data.
- Distinguish UB and 1500 validation issues that should be reported to management.
- Contact patients and third party payers to facilitate timely resolution.
- Document contacts and information obtained.
- Ensure compliance with hospital and department policies and procedures and pertinent laws and regulations.
- Maintain consistent audit trail including notating patient accounts accurately and professionally.
- Negotiate and complete execution of payment for non-contracted payers in accordance with hospital standards
ADDITIONAL RESPONSIBILITIES
- Use data to evaluate accounts receivable and create and/or revise work plans.
- Maintain orderly work area.
- Participate in departmental process improvement.
- Participate in team and individual goal setting and achievement.
- Use available resources for system troubleshooting.
- Perform tasks that are supportive in nature to the essential functions of the job.
- Participate in staff meetings, educational programs, committees, and mandatory in-services.
- Demonstrate initiative in personal/ professional development.
- Present a professional image.
- Assist with control of costs through the judicious use of human and material resources.
- Other duties as assigned.
EDUCATION AND WORK EXPERIENCE
- High school diploma or equivalent.
- Minimum of one (1) year general office experience and/or equivalent education of job related activities are required.
- Must have a working knowledge of Microsoft Word and Excel programs
- Minimum of one (1) year experience of medical billing or insurance processing
- Medicare billing knowledge preferred
KNOWLEDGE AND SKILLS
Knowledge of payor processing and requirements, understanding of claim editing, knowledge of general accounting principles and transaction balancing standards, ability to understand data presented by system generated reports, ability to prioritize duties and assignments and meet deadlines, understanding of multiple systems data exchange, ability to function effectively under stress, strong telephone communication skills, must be able to communicate effectively with strong attention to details and problem solving both verbally and written, and must possess an aptitude for researching and reconciling variances on patient accounts.