Job Description
Summary:
The Medical Biller is responsible for preparing, reviewing, correcting, and updating insurance claims for submission to payers,
Typical Schedule:
Full Time, Monday through Friday, Days
Onsite training/onboarding will be required.
Qualifications:
Recent experience in hospital billing required. Critical Access and/or Rural Health Clinic experience a plus. Experience in charge capture, coding, revenue cycle management, patient accounting and/or physician billing a plus.
Experience with EPIC EMR preferred.
Medical Terminology preferred.
High School Diploma required.
- Responsibilities include:
- Investigating & resolving claim denials
- Identifying denial patterns and managing insurance project resubmissions with multiple claims
- Validate denial code/reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billed
- Analyze all coding adjustments made on EOB to ascertain accuracy and valid support
- Review Summary Plan Descriptions and related insurance documents to ascertain benefits
- Determine and execute best approach for denial resolution and processing appeal
- Ensure timeliness of all appeals according to Federal, State and plan guidelines
- Generate appeals based on the dispute reason(s)
- Document all actions taken during the appeal process and any follow-up required
- Request and obtain medical records, notes and/or copy of claim as appropriate
- Resolve appeal claims with third party payers
- Knowledge, Skills & Abilities:
- Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements.
- Knowledge and use of payer medical policy and Medicare LCD/NCD criteria.
- Knowledge of billing and coding requirements
- Must have the ability to effectively utilize Microsoft Office
- Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints.
- Must have high-level skills in organization as well as problem solving and analytical skills.
- Capacity to manage time effectively, attention to details, and follow through.
- Well-developed research skills.
- Advanced technical skills to quickly learn hospital information systems
- Knowledge of contracting and credentialing implications on revenue cycle functions
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