Contractual Healthcare Biller

Description

The healthcare biller is responsible for daily follow-up of Accounts Receivable, denials and appeals. Works with insurance carriers to resolve billing and claims issues, as well as provider enrollment and maintenance, per individual carrier guidelines.

Position requires two or more years' experience in billing processing claims, appeals and denials. Must have a strong understanding of medical terminology, ICD-10 codes, CPT codes, HCPCS and the ability to understand an EOB (Explanation of Benefits).

Requires attention to detail, ability to exercise good judgment and discretion as well as time management skills. Effective verbal and phone communication skills. Coding certification preferred but not required.

Roles and Responsibilities:

• All Billing & Coding Activities.
• Evaluates medical record documentation to ensure proper CPT and ICD-10 codes are billed appropriately.
• Knowledge of 3^rd party payers, professional billing, provider credentialing, atypical Medicaid providers, SDOH.
• Knowledge of emerging billable activities, such as community health workers and MTMs.
• Credentials providers with insurance companies and maintains provider rosters/information.
• Collects, imports, posts, and manages insurance and patient payments.
• Monitors claim status and corrects/appeals rejected/denied claims.
• Reviews delinquent accounts and contacting patients for collection purposes.
• Answers questions regarding account balances.
• Other duties as assigned and subject to change as requirements evolve.

Qualifications

• High school diploma or equivalent – healthcare specific training preferred, but not required.
• Strong communication skills, both written and verbal.
• Self-motivated, detail-oriented, and able to work independently.
• Ability to maintain strict patient confidentiality and adhere to US HIPAA laws and other relevant regulations.