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
- Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from employees and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations
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