Medical Biller

Organization committed to improving health and ending homelessness.

REMOTE WORK
FLEXIBLE SCHEDULES
EXCELLENT TEAM
EXCEPTIONAL BENEFITS AS A CONTRACTOR

GOALS:

• Follows up on outstanding claims in a timely manner according to the assigned inventory and follow-up guidelines.
• Completes denials and appeals within set guidelines.
• Identifies Insurance Refunds and submits to Manager for review and approval.

RESPONSIBILITIES:

• Retains methods to expedite claim adjudication by resolving issues in ERA Denied claim status that may delay processing of payments. Research errors and makes necessary edits to claims that will make the claim ready for submission. Involves the patient and guarantor when necessary.
• Provides feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission. This should be documented on the issues log.
• Calls insurance companies daily and as needed, to determine when payments will be made and determines if any additional information is required to process suspended claims. Notates practice management software (eCW) with findings.
• Works a minimum of 65-70 claims daily in eCW.
• Reviews and proposes a minimum of 10 refunds per week to the Billing Manager for approval and processing.
• Follows up on original and re-billed claims with Insurance Companies within 30 days of submission.
• Follows up on initial electronically billed out claims within 5 business days of submission.
• Follows up weekly on high dollar claims over $2,000.00. Notates practice management software (eCW) with findings and reports to Billing Manager and Director of Patient Billing of status weekly.
• Documents actions taken on each claim in practice management software (eCW) stating the following: who was contacted, what was found, and how it was corrected.
• Coordinates appeals of denials process with each payer, in accordance to the payers’ guidelines. Works with Billing Manager and Director of Patient Billing on coordinating denials with insurance representatives. Ensures claims do not fall into Timely Filing for adjustments.
• Reviews remittance advice for payment discrepancies and takes appropriate action for resolutions within 3 days of the received remit.
• Works claims to ensure billing is completed within timely filing guidelines of each payer.
• Ensures that Productivity Template is completed daily for review.
• Reviews and responds to all insurance correspondence within 5 business days of receipt. Urgent or time sensitive correspondence should be addressed within same business day of received if time permits, but at maximum the next business day, and coordinated with others on response as needed.

* Completes other duties as assigned by supervisor.

QUALIFICATIONS AND SKILLS:

• High School diploma required. Some college studies or Associates degree preferred.
• Minimum 2 years required and 4+ preferred experience in physician, dental and behavioral health business office environment, specifically in collection and billing.
• Maintains confidentiality in all matters that include Patient Health Information and employee data.
• Team player, highly organized and able to meet strict timely deadlines. Ability to prioritize and simultaneously manage all daily tasks.
• Ability to work in a fast-paced environment.
• Superior knowledge of computers including MS Office, Practice Management Systems (eClinicalWorks) payer’s website navigation and contract management.
• Able to perform basic and mathematical calculations, works credits on accounts and able to reconcile data.
• Proof of vaccination against COVID-19 is required. Will consider requests for reasonable accommodations for anyone who cannot be vaccinated for a religious or medical reason, subject to applicable law.

o In relation to remote work versus on-site expectations, this position is classified as the following:

• Remote: A majority of the position may be able to work remotely, but employees will be required to report to the office a minimum of twice per month.

* Please note that remote work designations are subject to change or fluctuate at any point in time and the supervisor may require in person learning for a specific amount of time after hire.