Biller

Purpose 

The Medical Billing Representative position bills insurance companies for all clinic claims and physician bills; pursues collection of all claims until payment is made by responsible parties; purses uncollected monies from insurance companies through zero balance audits; and performs other work associated with the billing and collection process.

Responsibilities

• Prepares and submits medical claims to third-party insurance carriers either electronically or by hard copy.
• Follows up with third-party insurance carriers and patients until claims are paid.
• Monitors claims for missing information and authorization/control numbers.
• Reviews accounts that are at a zero balance to analyze if money was left uncollected by clients. If under-collection is identified, files appeal to collect underpayment.
• May be called upon to serve as a representative in meetings and communications with clients and payers.
• Looked upon to serve as a lead in a specific billing area.
• Secures needed medical documentation required or requested by third party insurances.
• Processes rejections by either generating a letter of rejection to patient or correcting any billing error and resubmitting claims to third-party insurance carriers.
• Works with coders to ensure that correct diagnosis/procedures are reported to third party insurance carriers.
• Notify patients when claims have not been paid after time frames in established accounts receivable policy.
• Keeps updated on all billing and benefit changes for third-party insurance carriers.
• Knowledge of governmental billing regulation and guidelines.
• Ability to bill Inpatient and Outpatient governmental and commercial claims.
• Audit accounts to ensure that appropriate payments are paid by responsible parties.
• Posts third-party insurance remittance vouchers and all other forms of payment.
• Maintains confidentiality of all information.
• Completes work within authorized time to assure compliance with departmental standards, including meeting production and quality standards.
• Demonstrates knowledge of, and supports, both client’s and SCHCD's mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Answer Phone
  • Assist patients with arranging a payment plan, billing questions, insurance concerns.
• Posting Payments
  • Check spreadsheets daily
  • Ensure all payments are in Athena with EOB’s. 
  • If EOB is missing, check website or call insurance to obtain and upload to Athena.
  • Patent Cases- Check daily and call patients back.
• Closing of the Month
  • Ensure all missing slips are submitted to keep current
  • Ensure all time-of-service money is reconciled for current month
• Missing Slips
  • Input missing slips from providers and make rounds at Eden Valley
• Performs other duties as required.

Requirements/Experience

• Athena experience preferred
• Stress Management/Composure
• Results Driven
• Technical Capacity
• Problem Solving/Analysis
• Customer/Client Focus
• Teamwork Orientation
• Collaboration Skills
• Time Management
• Communication Proficiency