Medical Billing Representative
IN-PERSON ROLE, no remote option
Must have prior experience working as a Medical Biller
GENERAL SUMMARY
Responsible to gather charge information, maintain the insurance database, distribute insurance claims, and assist patients with insurance and self-pay billing problems. Additionally, the Patient Accounts Representative processes data and information to facilitate maximum and timely payments.
ESSENTIAL JOB FUNCTIONS*
Ø Responsible for clean claim submission.
Ø Approves and transmits EDI claims.
Ø Works EDI response reports to correct transmission errors from carriers.
Ø Researches all information needed to complete billing process. This includes working directly with physicians, referral coordinator and reception.
Ø Code information about procedures performed and appropriate diagnosis for services.
Ø Audit and edit daily batches and data to produce clean claims. Reconciles charges.
Ø Posts payments, adjustments, and transfer balances as required.
Ø Carries out research and follow up regarding accounts requiring additional documentation. Manages and works receivable accounts.
Ø Assists with coding and error resolution.
Ø Handles patient questions, on-site and by telephone, regarding problematic accounts.
Ø Pre-authorizes surgeries, medications and other procedures with third party payers as necessary.
Ø Collects prior authorizations requests initiated by physicians.
Ø Initiates prior authorization request to patient’s Insurance carrier.
Ø Work with patients for medication requests.
Ø Initiates letters of medical necessity from physicians.
Ø Participates in educational activities.
Ø Maintains strictest confidence.
Ø Maintains current knowledge of policies and procedures, as well as updated ICD-10 and CPT-4 coding and billing compliance knowledge.
Ø Must keep patient and business confidentiality at all times; follows HIPAA policies for patient privacy and has access to Level 2,3,4 PHI. Complies with OSHA and AAHC policies and procedures.
Ø Performs clerical and any other duties as directed by Manager.
PREPARATION, KNOWLEDGE, SKILLS & ABILITIES
Ø High School diploma or equivalent. Associates or Bachelors degree in business preferred.
Ø Five plus years of medical office billing or administrative experience.
Ø Knowledge of billing software, billing and compliance policies, and of third party billing and claims/collection procedures.
Ø Must possess a calm, reassuring, competent demeanor and the ability to be sensitive to patient needs, as well as maintain a positive and friendly attitude when dealing with difficult patients.
Ø Must have the ability to examine documents for accuracy, completeness and pay attention to detail.
Job Type: Full-time
Pay: $26.00 - $28.00 per hour
Expected hours: 40 per week
Benefits:
- Life insurance
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work setting:
- Clinic
- Medical office
- Private practice
Ability to commute/relocate:
- Chestnut Hill, MA 02467: Reliably commute or planning to relocate before starting work (Required)
Experience:
- ICD-10: 1 year (Required)
- Medical Billing / Claims: 1 year (Required)
- Start-to-Finish Prior Authorization: 1 year (Required)
Job-related location requirement:
- Candidates must be within a 25-mile radius.
Work Location: In person