The medical biller/collector is responsible for timely submission of claims to insurance companies from a wide variety of medical providers and facilities, as well as monitoring and ensuring payments for medical services are received in a timely manner. The person in this position may also function as an intermediary between health care providers, clients, patients and health insurance companies.
Duties and Responsibilities:
Reviews patient bills for accuracy and completeness; obtains missing information
Knowledge of insurance company or proper party (patient) to be billed; identify and bill secondary or tertiary insurances
Utilize a combination of electronic health record (EHR) to perform billing duties; maintain an accurate, legally compliant medical record
Process claims as they are paid and credit accounts accordingly
Review insurance payments for accuracy and compliance with contract discounts
Review denials or partially paid claims and work with the involved parties to resolve the discrepancy
Manage assigned accounts, ensuring outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment
Communicate with health care providers, patients, insurance claim representatives and other parties to clarify billing issues and facilitate timely payment
Consult supervisor, team members and appropriate resources to solve billing and collection questions and issues
Maintain work operations and quality by following standards, policies and procedures; escalate compliance issues to Business Office Manager.
Prepare reports and forms as directed and in accordance with established policies
Perform a variety of administrative duties including, but not limited to: answering phones, faxing and filing of confidential documents; and basic Internet and email utilization
Provide excellent and professional customer service to internal and external customers
Function as a contributing team member while meeting deadlines and productivity standards
Safety and Infection Control Responsibilities
Responsible to maintain a safe and clean environment, including department/unit based safety and infection control requirements.
ESSENTIAL ORGANIZATIONAL BEHAVIORS
Demonstrates behaviors that are consistent with the Medical Center’s Mission and Values
Performs job responsibilities in an ethical, compliant manner consistent with the Medical Center’s values, policies, procedures and code of conduct.
Works well with team members toward a common purpose. Reinforces the efforts and goals of the work group. Supports the team’s decisions, regardless of individual viewpoint.
Demonstrates flexibility in schedules and assignments in order to meet the needs of the Work Unit/Department.
Utilizes, maintains, and allocates equipment and supplies in a cost effective and efficient manner. Improves productivity through proper time management
Seeks feedback from customers and team members in order to identify and improve processes and outcomes.
Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites
Preferred experience with billing systems such as GE Centricity & SRS Caretracker
Strong written, oral and interpersonal communication skills; Ability to present ideas in a business-friendly and user-friendly language; Highly self-motivated, self-directed and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high pressure environment
Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE & EXPERIENCE
High School Diploma, OR equivalent .
Minimum of 1 year of experience posting in a health care setting
Preferred Certified Medical Reimbursement Specialist (CMRS) certification; or Associate’s Degree in Business Administration.
Strong background in customer service
Competencies in the areas of leadership, teamwork and cooperation
Strong ethics and a high level of personal and professional integrity
Ability to understand medical/surgical terminology
Educated on and compliant with HIPAA regulations; maintains strict confidentiality of patient and client information