Medical (ProFee) Biller

Medical (ProFee) Biller

Who is Athra Systems?

Athra Systems/Crosstown Mental Health is a dynamic and forward-thinking organization dedicated to offering a wide array of behavioral health services and solutions. We pride ourselves on fostering a supportive and inclusive work environment where every team member can thrive and contribute to our collective success. Previously a private pay/contact company, we are now expanding to accept insurance to help more people, and the whole company is quickly adapting.

Position Overview:

We are seeking a Medical Biller with comprehensive knowledge of insurance billing, from advising on intake calls to understanding provider chart notes and assisting with diagnosis coding. The Medical Biller will be responsible for the accurate and timely billing of all professional services claims and private pay patient accounts, ensuring all billing activities comply with applicable regulations. In this role, you will work closely with patients, insurance companies, and healthcare providers to resolve billing issues. If you have expertise in every step of the billing process, from intake to final payment, and are looking to join a rapidly growing company where you can specialize in a specific billing function in the future, this is an excellent opportunity to get in at the ground level.

Key Responsibilities:

Billing:

• Ensure charges from providers are submitted to the billing team per company policy.
• Prepare and submit accurate claims to insurance companies, government programs, and other third-party payers.
• Review patient accounts to ensure proper billing procedures have been followed and correct any discrepancies.
• Ensure timely submission of claims to maximize reimbursement.
• Monitor and follow up on unpaid claims, identifying and resolving any billing issues or errors.
• Process payments, adjustments, and write-offs according to company policies.
• Process all zero payments from insurances and manage denied claims through corrected claims, reconsiderations, and appeals within the required timeframes to maximize reimbursement.
• Review Program Memorandums as needed to ensure compliant billing practices.

Accounts Receivable:

• Determine if reimbursement is correct per contractual guidelines.
• Perform problem resolution for front-end billing, understanding matrix interpretation systems and possessing contract interpretation skills.
• Create and manage follow-up workflows.
• Understand payer rules and appeal guidelines, and be able to interpret and implement Medicare guidelines.

Compliance and Reporting:

• Stay up to date on healthcare billing regulations and ensure compliance with all applicable laws and guidelines.
• Assist in preparing reports on billing and collection activities for management review.
• Participate in audits and quality assurance activities as needed.

Qualifications:

Education:

• High school diploma or GED required; Associate's degree in healthcare administration, business, or a related field preferred.

Experience:

• Minimum of 2 years of experience in physician, hospital, or third-party billing, collections, or a related field.
• Extensive experience with insurance claim processing and patient billing procedures.
• Knowledge of databases to obtain eligibility information.
• Familiarity working with Electronic Health Record (EHR) systems and billing software.
• Experience in appeals, denials, underpayments, and 1500 billing forms.

Skills and Abilities:

• Strong understanding of medical billing codes (CPT, ICD-10) and insurance reimbursement processes.
• Excellent communication and interpersonal skills, with the ability to handle sensitive and confidential information.
• Strong organizational skills and attention to detail.
• Ability to work independently and as part of a team in a fast-paced environment.
• Proficient in Google Workspace, Microsoft Office Suite (Word, Excel, Outlook).
• Knowledge of Tebra Software preferred but not required.

Other Requirements:

• Knowledge of federal and state healthcare billing regulations, including HIPAA.
• Understanding of Chronic Care Management (CCM) and Provider Psychiatric billing.

Working Conditions:

• May require occasional evening or weekend work to meet deadlines or handle urgent issues.
• Requires sitting for long periods and using office equipment, such as computers, phones, and fax machines.

Benefits:

• Competitive salary commensurate with experience.
• Comprehensive benefits package including health and dental insurance for qualified candidates.
• Retirement plan with employer contribution for qualified candidates.
• Generous paid time off and holidays.
• Supportive and collaborative work environment.

Athra Systems/Crosstown Mental Health is an equal opportunity employer.