The main function of a medical biller is to submit medical claims to insurance companies and payers such as Medicare and Medicaid. Responsible for the timely submission of technical or professional medical claims to insurance companies. The position may be located in physician offices, hospitals, nursing homes, or other healthcare facilities.Job Responsibilities: Obtain referrals and pre-authorizations as required for procedures Check eligibility and benefit verification Review patient bills for accuracy and completeness and obtain any missing information Prepare, review, and transmit claims using billing software, including electronic and paper claim processing Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid Follow up on unpaid claims within standard billing cycle timeframe Check each insurance payment for accuracy and compliance with contract discount Call insurance companies regarding any discrepancy in payments if necessary Identify and bill secondary or tertiary insurances All accounts are to be reviewed for insurance or patient follow-up Research and appeal denied claims Answer all patient or insurance telephone inquiries pertaining to assigned accounts. Set up patient payment plans and work collection accounts Update billing software with rate changes Updates cash spreadsheet, runs collection reports
Skills: Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems. Use of computer systems, software, 10 key calculator Effective communication abilities for phone contacts with insurance payers to resolve issues Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds Able to work in a team environment Problem-solving skills to research and resolve discrepancies, denials, appeals, collections Knowledge of accounting and bookkeeping procedures Knowledge of medical terminology likely to be encountered in medical claims
Education/Experience: High school diploma Knowledge of business and accounting processes usually obtained from an associate's degree, with a degree in Business Administration, Accounting, or Health Care Administration preferred 2 to 4 years of experience.
* Understanding of the A/R process
* Ability to verify insurance
* Capable of meeting daily deadlines with little supervision.
* Computer proficient (able to maneuver between multiple windows, and multi-task)
* Analytical skills (able to identify trends)
* Experience with review and appeal of coding based denials: non-covered, bundling, duplicates
* 3-5 years related work experience (physician billing, collections, claims)
* Knowledge of duplicate, no authorization and coding denials preferred