Biller

SUMMARY

The Billing Representative will be responsible for the billing of Outpatient and inpatient and follow up of claims. This position will be instrumental in analyzing and following up on billed claims to determine the appropriate course of action to resolve the claims.

ESSENTIAL DUTIES & RESPONSIBILITIES include the following. Other duties and responsibilities may be assigned.

RESPONSIBILITIES:

• Resolve cash generating accounts expeditiously to bring in revenue for the company.
• Able to work an average of 40-50 accounts per day 100% of time
• Able to work accounts with 5% or less error ratio
• Follow-up on Managed Medicaid, Commercial and Essential claims by phone calls to the insurance companies, websites, if available, or any online resources.
• Understanding of medical terminology, diagnosis codes, denial codes, and calculating fee schedules.
• Experience in filing appeals on denied claims when appropriate while working each account/claim.
• Strong understanding of UBs, 1500s, Electronic Remittance Advice (ERAs).
• Ability to read and understand EOBs (Explanation of Benefits).
• Able to read and understand the 820 billing regulations and applying them when following up on Claims
• Has the experience to know the appropriate questions to ask when calling Managed Medicaid Insurance companies, Commercial and Essential plans to get the necessary information to move forward in resolving the claim.
• Understands Behavioral Health revenue cycle management (RCM) process and can apply when working account.
• Develops a solid understanding of assigned RCM processes to review and analyze claims and account receivable functions.
• Identifies RCM issues consistently and communicate this to their Manager timely for quick resolution.

COMPETENCIES (KSAs)

• Leadership
• Initiative
• Ethical Practices
• Judgment
• Relationship Management
• Emotional Intelligence
• Professional Boundaries
• Global and Cultural Awareness
• Critical Evaluation
• Problem Solving
• Decision Making
• Communication
• Teamwork
• Crisis Management
• Technical Capacity

EXPERIENCE

• Excellent written and verbal communication skills, on Program specifics processes.
• Excellent organizational, time management and problem-solving skills.
• Able to use the appropriate reason and status codes in the EMR system for each account
• Able to request the correct information from the appropriate entity when attempting to resolve the account.
• Able to ask the appropriate questions when calling insurance companies or state programs, or patient.
• Proficient in Microsoft Office Suite or similar software.

REQUIRED EDUCATION

• High school diploma or equivalent required.
• Associates degree or vocational school training preferred.

WORK ENVIRONMENT

• This job operates in an indoor office environment. This role routinely uses standard office equipment such as computers, phones and photocopiers.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

• Regularly required to sit, use hands to type, handle or feel objects, tools or controls; reach with hands and arms, and talk or hear.
• Frequently required to stand, walk, stoop, kneel or crouch and lift and/or move up to 30 pounds