Job Description

Under direct supervision, the Insurance Biller is responsible for all aspects of billing and collections activities including reviewing and auditing codes, verifying insurance, posting charges and payments and collection of monies from payors and/or patients.

Core Competencies

• Posts hospital and office charges and payments.
• Reviews explanation of benefits to resolve accounts.
• Reviews claim scrubber and resolves claim edits.
• Identifies and resolves payer issues and patient billing complaints
• Maintains payor-related items, such as EFTs and Payor IDs for 835s.
• Manages staff to oversee Explanation of Benefits are returned to staff within 1 week of request.
• Verifies insurance eligibility and authorization.
• Transmits electronic/ remittances and statements.
• Works monthly aging of PPO's, Medicare, HMO's, cash and Workers Compensation.
• Runs aging and month end reports.
• Documents detailed notes including action items taken, when appropriate.
• Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and other departments.
• Performs collection actions including contacting patient, insurance companies, or third party payers.
• Reviews reports to identify denials from Medicare, PPOs, Worker Compensation, Commercial and Contracted carriers; corrects and resubmits claims using accurate ICD-9,ICD-10 and CPT codes; suggests action plans to eliminate denials in the future.
• Prepares and submits write off requests to Supervisor for denied claims that cannot be appealed.
• Elevates issues as appropriate to Supervisor.
• Participates in Performance Improvement.
• Assists with orientation and training of new employees/ volunteers, as assigned.
• Understands basic computer programs.

Department Specific Competencies

Education

DegreeProgramN/AN/A

Additional Information

Experience

Number of Years ExperienceType of Experience1

Additional InformationOne year biller/collection experience in medical office or hospital. Basic accounting skills. 10 key by touch

License / Certification Requirements

Compensation Range:

$25.00 - 33.44 / Hour