Biller

This position is fully remote with equipment provided.

Please only apply if you live in the following states:

• NC

• CO

• MA

• NC

• GA

• FL

• TN

• TX

• AZ

• KY

Pay: $18-$20

Schedule: M-F 8am-5pm PST; 11am-8pm EST (some flexibility here if needed)

Job Description Summary:

We are seeking a dedicated and detail-oriented Insurance Account Representative to manage a portfolio of accounts within our Client Partner's Government, Non-Government, TPL, or Worker's Compensation Accounts Receivable. This role is crucial in ensuring the rapid, compliant, and patient-centric resolution of balances, ultimately maximizing our Client Partner's financial performance.

Key Responsibilities:

• Utilize knowledge of managed care contracts, payer behaviors, and clean claim statutes to influence payer intent and overcome payment delays or objections.
• Understand expected reimbursement for assigned payers; identify and resolve payment discrepancies.
• Submit and re-submit UB-04, 1500, and other claim forms, accurately completing each field locator and attaching necessary documentation (e.g., itemized statements, medical records).
• Collaborate with payers and patients to resolve coverage, coordination of benefits, and authorization issues impacting claim resolution.
• Manage the printing and mailing of claims.
• Consistently document all payer and patient interactions in the hospital's source system and/or Excalibur's workflow solution.

Skill Sets and Experience:

• Proficient with UB-04 and CMS 1500 forms.
• Comprehensive knowledge of government and non-government payers.
• Experience with EMR systems (Epic, Cerner, Meditech preferred).
• Expertise in insurance follow-up, payer behavior, and guidelines.
• Ability to toggle between multiple systems and maintain organizational efficiency.
• Excellent documentation, written, and verbal communication skills.
• Proficiency in Microsoft Office products including Outlook, Word, and Excel.
• Understanding of HIPAA and related privacy and security regulations.
• Team player with a passion for healthcare.

Education:

• High School Diploma or equivalent is required.

Must Have Skills/Qualifications:

• Experience with both in-patient and out-patient claims.
• Knowledge of Medicare/Medicare Advantage and commercial claims.
• Proficiency with both UB-04 and 1500 claim forms.
• A minimum of 2+ years of relevant experience.

Additional Information on Responsibilities:

• Billing for all payors, including Medicare/Medicare Advantage and commercial claims.
• Managing claims for both in-patient and out-patient services.
• Utilizing claim scrubbers, correcting edits, and ensuring timely claim submission.
• Handling a backlog from the Trizetto transition.
• Managing an average of 45 claims per day, with volume depending on claim value.
• Following up with providers to ensure timely claim payments.
• Working complex denials for all payers and processing adjustment requests.
• Processing appeals and denials, using templates or free-style as needed.
• No direct patient communication; patient-related issues are handled by the patient accounts team.
• Working with UB-04 and 1500 claim forms within the Cerner EMR system.

If you have the skills and experience required for this role and are passionate about making a difference in healthcare, we encourage you to apply.