What are the responsibilities and job description for the Medical Biller/Collector III position at KORE1 Technologies?
Job Summary:
This is a Hybrid Medical Biller/Collector III role based out of Baldwin Park, CA. In this position, you will work on complex billing and collections functions, ensuring accurate and timely submission of claims and effective follow-up to maximize reimbursement.
Key Responsibilities:
- Billing & Claims Management:
- Prepare, review, and submit professional and institutional claims to government and commercial payers.
- Review EOBs/ERAs to ensure payments are accurate and processed according to contract terms.
- Correct and resubmit denied or rejected claims; manage appeals and reconsideration requests.
- Monitor timely filing limits and ensure all claims are submitted within the allowed period.
- Collections & Account Follow-Up:
- Follow up on outstanding balances from payers and patients, ensuring timely and complete collections.
- Conduct thorough account reviews, identify root causes of denials or underpayments, and resolve them effectively.
- Work closely with insurance companies, patients, and internal departments to resolve complex billing issues.
- Maintain detailed notes in the billing system to track actions and progress on each account.
- Compliance & Documentation:
- Ensure billing and collection practices comply with federal, state, and payer-specific regulations, including HIPAA and CMS guidelines.
- Stay current with changes in insurance policies, coding rules (ICD-10, CPT, HCPCS), and reimbursement trends.
- Assist in auditing accounts to ensure accuracy, compliance, and optimal reimbursement.
Requirements:
- Minimum Qualifications:
- High school diploma or equivalent (Associate's degree or billing certification preferred).
- 5 years of progressive experience in medical billing and collections, preferably in a hospital or oncology setting.
- Strong knowledge of Medicare, Medi-Cal, commercial payers, and managed care contracts.
- Proficient in Epic, Cerner, or other hospital billing systems.
- Understanding of CPT, ICD-10, and HCPCS coding, and medical terminology.
- Ability to analyze claims and interpret payer policies and remittance advices.
- Strong problem-solving, communication, and organizational skills.
- Ability to work independently and collaboratively in a fast-paced, mission-driven environment.
- Preferred Qualifications:
- Certified Professional Biller (CPB) or Certified Revenue Cycle Representative (CRCR)
