Responsible for correctly processing healthcare claims to obtain reimbursement to various third party payers and patients, ensuring proper account documentation in the facility’s billing system, and pursuing follow-up efforts on aged accounts. As needed, this individual is responsible for completing or assisting with special projects related to the medical billing department. Biller will also resolve credit balances on account as defined in the credit balance policy. This position follows a hybrid work structure where employee can work remotely or from the office as needed, based on demands of specific tasks and work performance.

Functional Demand:

FLSA: Nonexempt

Department: Jennie Stuart Medical Group

Reports to: Supervisor

Supervises: None

Physical Demands: Regularly (R). Essential (E) or Non-Essential (NE)

Vision (Corrected/Normal), Colored VisionHearing (Corrected/Normal)Sense of Touch, Sense of Smell, Finger DexterityTemperature Discrimination, Clear Oral CommunicationPushing, Lifting, Lifting (Floor to Waist), Lifting—12” to waist, Lifting—Waist to Shoulders,Lifting—Shoulder to Overhead, Reaching Overhead, Reaching ForwardCarrying, Standing, Sitting, Squatting, Stooping, Kneeling, Walking, Running, Crawling, ClimbingStairs (Ascending/Descending)Turning (Head/Neck), Repetitive Leg/Arm Movement, Use of Foot or Hand Controls

Organizational Expectations

Provides a positive and professional representation of the organization.

Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.

Maintains standards for a clean and quiet patient environment to maintain a positive patient care experience.

Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.

Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.

Participates in ongoing quality improvement activities.

Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.

Complies with organizational and regulatory policies for handling confidential patient information.

Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.

Adheres to professional standards, policies and procedures, federal, state, and local requirements, and/or standards from other accrediting bodies, such as The Joint Commission, Rural Health, and Center for Medicare Services.

ESSENTIAL FUNCTIONS

Provides exceptional customer service.

Answering and referring inquiries within scope of business services.

Telephone: Answers telephone, processes call, and document appropriately.

Returns all messages in a timely manner.

Maintains communication between medical providers, administrative staff, and/or patient/families.

Prepares and submits claim for insurance reimbursement.

Reviews, works, and corrects both internal errors and denials from insurance companies and re-files claims.

Reviews, evaluates, and forwards manual patient account statements to payers that do not accept electronic claims or that require special handling such as client billing.

Files appeal to carriers according to guidelines, documents all information related to appeals and follows up until resolution is reached.

Scans and uploads patient clinical documents into medical charts.

Ensures all provider services are accounted for and billed.

Handles billing complaints and discrepancies.

Assists patients with the collection of payments on outstanding balances.

Documents billing activity on the patient account; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to department leaders

Reviews claims for accuracy and coordinates with ancillary departments as needed to provide information for audits/and or record reviews.

Based on electronic payers’ error reports, makes appropriate corrections to optimize the electronic claims submission process.

Pursues prompt follow-up efforts on aged accounts, which may involve helping to formulate written appeals.

Monitors claim rejections for trends and issues; reports these findings to supervisor or director.

Practices excellent customer service skills by answering patient and third-party questions and/or addressing billing concerns in a timely and professional manner.

Assists in reviewing and/or resolving credit balances.

Participates in general or special assignments and attends required training.

Contributes to the overall cleanliness and appearance of personal workspace and department.

Monitors supply levels and requests when needed.

Evaluates all equipment for damage or maintenance needs and reports when needed.

Non-Essential Functions: All other duties as assigned

Ability to maintain accuracy while working on multiple tasks in a fast-paced environment under low to moderate supervision.

Good verbal and written communication skills, including professional telephone etiquette

Strong computer skills (MS Word and Excel)

Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance.

Dependable in both production and attendance

Good organization and time management skills

Ability to work tactfully and effectively with patients, family members, other employees and physicians.

Analytical abilities, Word Processing, Strong customer service, Multi-tasking, Time Management

Organization, Attention to Detail, Professionalism / Positive Attitude, Quality Focus, Adaptability

Minimum Education: High School diploma or G.E.D equivalent

Minimum Work Experience: One year or more experience in a medical office working with insurance claims.