The Medical Biller, a key position in the Revenue Cycle, manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. The incumbent will assist in the clarification and development of process improvements and inquiries, assure payments related to patient services from all sources are recorded and reconciled timely in order to maximize revenues.
Essential Duties and Responsibilities
Obtain, verify, and update patient demographics and insurance information within the practice management billing system patient insurance and claims addresses.
Entering insurance information and responsible party information into the patient’s chart
Processing encounters and claims in the electronic medical records system.
Applying all coding rules and use of CPT and E/M codes
Posting payments when necessary and notify the practice manager when charges are declined
Notifying patients about billing procedures and following up with them in a prompt, courteous manner
Communicating with insurance companies regarding prior authorizations, denials, revisions, and other issues as they arise and follow up until it is resolved.
Directing notes that need to be completed, adjusted, and/or corrected to supervisors for revision
Access patient records as needed for review by physicians, technicians, and other medical staff members.
Follow up on submitted claims, monitors unpaid claims, and resubmit claims with appropriate corrections and documentation.
Analyze claims system reports to ensure that underpayments are correctly identified and collected from key carriers.
Ensure that established billing targets for collections, gross, days in A/R and net collection ratios are met.
Accurately and efficiently processes requests for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid insurance payers.
Researches and response to documentation requests from insurance carriers in a timely manner.
Runs account receivable reports monthly and follow up on all outstanding claims greater than 60 days.
Documents clear and concise activities performed in the system for each account worked.
Adheres to all HIPAA (Health Insurance Accountability and Portability Act) guidelines and regulations.
Ability to consistently maintain productivity and quality expectations as defined by management.
Alert management to irregularities, insurance trends and areas of concern with reimbursement
Completes other tasks and responsibilities as assigned.
Associate degree required (Bachelor’s Degree in Business or related field preferred)
2+ years experience as a Medical Biller
Proficiency with electronic medical records (EMR)
Working knowledge of CPT and ICD-9 & ICD-10 coding systems; Coding certification preferred
Strong knowledge of Microsoft Office Suite
Ability to work independently and collaboratively within a team environment