Medical Biller

Schedule: Monday-Friday 8AM- 5PM

To provide thorough follow-up and/or re-billing of unresolved hospital (UB04) and possibly physician
(1500) insurance claims. The project has claims from a variety of payer types including Medicare,
Medicaid, Managed Care, Blue Cross Blue Shield, and Commercial insurance companies.

• Responsible for performing claim research and electronic claims follow-up work with multiple
  insurance companies either by electronic system or phone depending on insurer, to resolve
  accounts which have been billed but remain unresolved.
• Reviewing notes on client systems to see what work has already been performed.
• Determining next steps by either using electronic tools or calling the insurance company to determine claim status, depending on insurer.
• If no claim is on file, it will need to be re-billed electronically through the client's systems.
• If a claim is rejected, find out why and make a determination if it can be re-billed with proper information, if it should be patient responsibility, or if it is a timely filing issue.
• If coding needs to be changed, submit to appropriate group for review.
• Work specific payers/insurers and accounts as assigned by management.
• Responsible for submitting accounts to be written off or changed to patient responsibility.
• Responsible for claim denials and determining how to resolve the claim either by correction, re-billing, or if it was rejected authorization issues.
• Maintaining a productivity of 40 accounts/day with a 90% quality rating.
• Responsible for working from multiple computer systems simultaneously and learning them quickly.
• Perform limited training and support to billing associates being moved to a new client or those simply needing assistance.
• Receive ongoing training on different payer mixes, clients, and client systems.
• Following all Federal and State guidelines concerning the proper handling of medical receivables.

Minimum of 2 years' experience in a hospital / physician business office performing billing and claim follow-up work with direct hospital billing and/ or physician experience being preferred.

Experience with at least one of these payer types is required, with multiple being preferred: Medicare, Medicaid, Managed Care, Blue Cross Blue Shield, or Commercial Insurer.

• Microsoft Windows operating systems (Windows 7 and 10)
• Microsoft Office Productivity Suite (Word, Excel, and Outlook version 2016)
• NaviNet - to look up insurer claims and EBOs, and do claim investigations as needed
• Be able to learn multiple separate client computer systems
• Oral and written English language skills
• Be comfortable talking to others over the phone for extended time periods
• Being assertive with insurance companies to resolve issues
• Demonstrate very strong billing and multiple insurance company follow-up skills
• Be able to work in an environment that promotes positive customer service practices
• Be able to work independently, multi-task, and follow instructions
• Thorough knowledge of medical terminology (EOB's, DRG's HCPCS's, CPT & ICD codes, etc.)
• Thorough knowledge of UB04 forms and 1500's
• Working knowledge of medical billing systems and normal healthcare billing workflows.